ICD10 and Your Documentation Gap Analysis

With a project as large and potentially daunting as the looming ICD10 conversion (go-live date of October 1, 2013 for those of you living under a healthcare rock), one of ht major tasks you should have undertaken or need to, is a gap analysis on your documentation.

But, where do you being and where does it end?

First, believe in the mantra ALL CODES ARE NOT CREATED EQUAL.

There is only so much time you can devout to this analysis and any educational offerings thereafter to try and mitigate any large risks so you need to realize early that smaller specialties or codes aren't going to be able to get the kind attention that higher weighted codes may be.

For example, a hospital may not really focus on Podiatry patients as it may be low volume and possibly low weighted DRG payments, but a Podiatry practice would be the opposite.  So it all comes down to each individual facility.

So start with what you know...or better yet, what your coders know.  They should already be acutely aware of what DRGs or specialties have problems with documentation.

So start big, picks a few specialty or DRGs that you know your facility has a lot of and can be problematic.  Run some random reports to get patient lists and then try coding them using ICD10 (either through encoder or the book) and make notes as to where there are gaps that lead to a wide range of possible ICD10 codes.

This is great data to share with your doctors since it will help guide them on what they will need to do to expand the detail of their documentation (theirs an oxymoron for you).

Another piece to consider is contracting with a vendor to do the financial impacts.  While it may be possible to do this in house, the bottom line is that number of permutations and data that you'll be reviewing is so large that doing it in-house is probably use not feasible (also, consider the time constraints).

One great thing a third party can do is run the different variables on all your inpatient claims to see what possible DRGs they may roll up (or down) to in ICD10.  Since one I9 code will have many I10 code possibilities, these vendors can run all the permutations and different variables of those codes, so if you have a claims that has one code with 10 possible I10 codes, they can run it all 10 times and see how the final DRG plays out.

This isn't the end of your analysis...just the beginning.....