Health Language Blog

Outpatient Claims: Optimize Clinical Documentation that Supports ICD-10

Posted on 06/23/15

Clinical-Documentation-Outpatient-Claims

There has been a great deal of discussion around ICD-10 and how it will impact DRG’s – but what about the outpatient setting?

 Good news, CPT is not changing. However, outpatient documentation will need to support the specificity required to capture the most precise ICD-10 diagnosis code(s).  One way to approach Clinical Documentation Improvement (CDI) training for the clinics and ER is to identify the top unspecified ICD-9 diagnosis codes. If you’re aware of unspecified ICD-9 codes in use today within your organization, you’ll need to consider the following:

  • Where these unspecified codes selected because of limitations within ICD-9?
  • Does your existing the documentation lack specificity?
  • Are your coders just defaulting to unspecified codes?

Taking the answers to the above questions into account is a great way to establish a foundation for the upcoming transition for your outpatient practices to understand if your current documentation practices provide the specificity required in ICD-10.  From there, you’ll need to tailor any documentation or educational programs for your providers and coders that are specific to their practices or service lines.

To help you succeed, you should consider utilizing analytics software to process your 837P claims files or files representing the clinician’s bill or professional fees.  Software can help you expedite the process by producing several reports that will assist your team with establishing priorities to successfully execute your outpatient ICD-10 remediation program.

Here is an excerpt of an ICD-9 unspecified report. This report shows a provider’s current top ICD-9 unspecified codes and can be used to help identify documentation and coding requirements for ICD-10.

Screen_Shot_2015-06-22_at_7.36.06_PM

If it is unspecified today, it will most likely be unspecified in ICD-10.  Next step – what needs to be documented to ensure the coders are able to select the most precise, specific code?

In addition to leveraging a software analytics tool, you should also consider outsourcing a service that can take this report and generate instructional notes to help mobilize your outpatient remediation program. As illustrated in simplified deliverable below from our own Professional Services organization, itemizing the documentation requirements based on the prioritization established by the above report will be critical for ensuring a successful transition in October.

Screen_Shot_2015-06-23_at_10.45.03_AM

There’s a lot to do to ensure your team is prepared and I strongly recommended that you work with team of professionals to mine the data and gain insights into your outpatient claims documentation. This will ensure your clinical documentation improvement recommendations are presented accurately. Customize the outpatient ICD-10 CDI notes by Provider, clinic, and/or service line.

As October approaches, look under the hood today, and ask yourself if there areas that can be improved upon now? Thinking beyond ICD-10, does the current documentation support your HCC initiative?

Stay tuned for future blogs regarding HCC’s!

Have you prioritized and optimized your documentation in the outpatient setting?  Leave your comments below.

ICD-10 Transition for Providers

Topics: ICD-10

About the Author

Deborah Szymanski Deborah Szymanski RN, BSN is an Account Manager and Clinical Specialist at Health Language. Deborah started her healthcare career as a nurse in the Emergency Department. Deborah has spent the last six years working in medical software, yet still is very involved in the ER nursing field.