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EHR Optimization a Focus of Upcoming ICD-10 Updates

A new guide aims to prepare healthcare practices for the next phase of ICD-10 implementation, which includes new codes and regulations on unspecified codes that will require certain EHR optimization efforts.

By Jacqueline LaPointe

- Many healthcare providers, whether reluctantly or not, have already implemented ICD-10 coding procedures and continued to provide care with the system in place. However, like many aspects of the industry, providers will need to prepare for upcoming updates and changes to ICD-10 on October 1, 2016.

EHR optimization key to next phase of ICD-10 implementation

To assist healthcare stakeholders, the American Health Information Management Association (AHIMA) has released a guide on how to manage ICD-10 post payment reviews and unspecified codes. Per the guidance, healthcare practices should also evaluate their EHR systems to ensure that coding errors have been reported. Many EHR systems are designed to suggest the correct ICD-10 codes, but some stakeholders have noticed that these systems are not perfect.

“While the correct level of ICD-10 code specificity has always been required for National Coverage Determinations, Local Coverage Determinations, other claims edits, prepayment reviews, and prior authorization requests, physicians were granted amnesty from post payment reviews due to unspecified codes,” wrote Christina Lee, MHS, RHIA, CCS, CPC, in the AHIMA newsletter.

Once the grace period ends on October 1, healthcare stakeholders should realign their ICD-10 resources to focus on unspecified ICD-10 codes, which could cause delays in claims reimbursement, explained Lee. Even though ICD-10 hinges on accuracy, there will be cases where providers will need to use an unspecified code.

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  • “When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example, a diagnosis of pneumonia has been determined but the specific type has not been determined),” explained CMS in an ICD-10 Overview document.

    AHIMA advised that healthcare practices start by performing internal audits that identify and track patterns in unspecified clinical documentation and diagnosis code assignments.

    If the analysis shows that more specific ICD-10-CM (diagnosis) codes could have been used based on the clinical documentation, then practices should conduct trainings on proper coding techniques. On the other hand, if analysis shows that incomplete medical documentation resulted in unspecified codes, practices should refresh clinicians on appropriate documentation procedures.

    “While there are a few instances where usage of unspecified ICD-10-CM codes may be appropriate, widespread use of numerous unspecified codes should be the exception, not the rule,” stated Lee. “Practices submitting unspecified ICD-10 codes after October 1, 2016 may potentially experience an increase in post payment audits and quality reporting errors. As audits increase, so will payer requests for medical records and clinical documentation.”

    Additionally, healthcare practices may want to consider hiring a certified coding professional to assist with updating ICD-10 coding procedures and compliance policies, explained Lee. A coding specialist can help providers assess EHR code assignments, pinpoint software glitches, and provide ICD-10 training for staff.

    AHIMA noted that many practices may not be able to afford a full-time coding specialist, but there are cost-conscious ways to employ a professional. Practices could collaborate with other providers to share the cost, hire a certified specialist via a contract or a consulting arrangement, allow a current employee to complete coding certification, or employ an interim coding professional.

    The guide stated that common coding glitches include codes for motor vehicle accidents, joint replacements, and traumatic fractures.

    Looking forward, AHIMA predicts that more healthcare providers will experience challenges with the upcoming release of new codes as CMS ends the three-year code freeze. Practices may also face difficulties with statistical reporting because unspecified ICD-10 codes from 2016 will be compared to more specific codes in 2017.

    “A proactive approach to mitigate unspecified documentation, coding, and billing is the best remedy for post-grace period concerns,” reported Lee. “Now is the time for practices to consider hiring credentialed coding professionals and/or partnering with coding consultants. HIM professionals will become increasingly valuable as physicians prepare for the new wave of coding challenges ahead.”

    Assessing EHR systems and ICD-10 capabilities may be a worthwhile task for healthcare providers as the new phase approaches. A recent WEDI survey found that the majority of healthcare stakeholders surveyed stated that EHR and practice management systems facilitated a smooth transition to ICD-10 implementation.

    As the healthcare industry continues to change, ICD-10 is no exception to that rule. However, practices could benefit from AHIMA’s guide on the approaching updates, especially as EHR systems are restructured to accommodate more ICD-10 codes.

    Dig Deeper:

    Impact of ICD-10 on Smaller Provider EHR Use, Reimbursement

    Factors Contributing to Hospital EHR Implementation Success



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