The Translation Gap: ICD-10 and HCC

5/26/2013 – Kameron Gifford, CPC

Where will ICD-10 impact your organization the most? What are you doing to protect your revenue?

The greatest hurdle in transitioning to ICD-10 will be improving clinical documentation.

Are your providers documenting with the specificity required for ICD-10? If not, where do you focus your education?

If you have not already completed a revenue risk assessment, I urge you to do so now! This will be your greatest key to success!

Start with a Revenue Risk Assessment for your Organization:

Medicare Advantage Plans/ MSO’s / IPA’s:

1.       Compile a list of your most frequently billed ICD-9 Codes per provider. (A list of 25 is sufficient).

2.       Map these codes into the corresponding ICD-10 Codes.

3.       Map ICD-10 Codes to Corresponding HCC’s to determine potential impact on revenue.

Prior, Proper, Planning…

Once you have determined the potential impact on revenue we can use this same information to create meaningful education to improve clinical documentation.

We are by nature, creatures of habit, and we must start changing the behavior of providers now to ensure adoption of new concepts.

A few examples of these include:

• Laterality – left, right, bilateral or unilateral

• Trimester of pregnancy and weeks of gestation

 • BMI calculation in Obesity

 • Which finger, and which level in a finger amputation

• The type of surgical approach for procedures

 • The severity of seizures

• The severity of retinopathy or renal disease in diabetics

Compliant coding begins with compliant documentation. Through accurate risk revenue assessments organizations can concentrate their efforts; thus encouraging greater engagement.

If your organization needs help contact ERM. We will audit up to 10 dates of services or map 10 codes at NO CHARGE.