Pinson and Tang CDI Pocket Guide
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ICD-10 Myths vs. Facts

August 27, 2014

On August 4, the U.S Department of Health and Human Services issued a final rule to implement ICD-10-CM and ICD-10-PCS on October 1, 2015. While it is possible that Congress could overturn this regulation as occurred after the 2014 Final Rule, ICD-10 stakeholders are encouraged to take the steps necessary to ready their organizations by October 1, 2015.

Education of your CDI Team and medical staff is likely on your ICD-10 preparation list.  We encourage you to take a pragmatic approach to this endeavor. The mantra that all available specificity must be taught so that it will be documented and can be coded is misguided.  This "shotgun" approach overwhelms the learner and risks the dilution of necessary documentation having a real impact, which translates into lost revenue.

We at HCQ Consulting have thoroughly studied and analyzed ICD-10 to strategically identify documentation vulnerabilities pertinent to MS-DRGs. This month we are pleased to provide you with a series of ICD-10 documentation myths & facts.  We hope you find these helpful.

Myth:  Acute respiratory failure must be specified as either hypoxemic vs. hypercapneic in ICD-10.

Fact:  ICD-10 allows coding of hypoxemic vs. hypercapneic acute respiratory failure but this specificity is not required. 

The code for acute respiratory failure unspecified whether hypoxemic or hypercapneic is J96.00. Respiratory failure unspecified whether acute or chronic and unspecified whether hypoxemic or hypercapneic codes to J96.90.  Both J96.90 and J96.00 are MCCs.

Myth:  The increased number of codes in ICD-10 will make the new coding system impossible to use.  

Fact:  Just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD-10 doesn’t necessarily make it more complex to use. In fact, the greater number of codes in ICD-10 make it easier for you to find the right code. In addition, just as you don’t have to search the entire list of ICD-9-CM codes for the proper code, you also don’t have to conduct searches of the entire list of ICD-10 codes. The Alphabetic Index and electronic coding tools are available to help you select the proper code.

The improved structure and specificity of ICD-10 will likely assist in developing increasingly sophisticated electronic coding tools that will help you more quickly select codes. Because ICD-10 is much more specific, is more clinically accurate, and uses a more logical structure, it is much easier to use than ICD-9-CM. Most physician practices use a relatively small number of Diagnosis Codes that are generally related to a specific type of specialty. 

Source: CMS ICD-10-CM/PCS Facts and Myths 


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