With ICD-10 go-live in the rear view mirror it is still imperative to look at the road ahead.  Provident has been working with its clients to monitor and identify trends in ICD-10 coding to ensure the transition to ICD-10 remains as seamless and effortless as it was on October 1, 2015.

Through our ongoing auditing we have identified several opportunities for improvement in coding practices.  In addition to these new trends and opportunities, as anticipated, many of the top documentation improvement opportunities that existed with ICD-9 continue to be top opportunities with ICD-10 (e.g. CHF specificity, presence of encephalopathy).

We have identified 4 ways to immediately improve the accuracy of coding within your department.

1. Pay close attention to procedural coding (ICD-10-PCS), particularly for procedures that shift the DRG from medical to surgical DRGs
   • Valid shift (procedure coded correctly)
     • example – Paracentesis that is performed for diagnostic and therapeutic purposes (when coded correctly, shifts the DRG)
   • Invalid shift (procedure coded incorrectly)
     • example – Insertion of an arterial line to monitor blood pressure in the ICU (if coded correctly, does not shift the DRG)
   • A good rule of thumb is, if a procedure in ICD-9 did not shift the DRG, but now shifts the DRG in ICD-10, it may be worthwhile to get a second opinion about whether the PCS code selected is correct
   • Debridement coding is different with ICD-10 – non-excisional debridement of subcutaneous tissue and fascia tissue code will group to a surgical DRG. Skin is excluded. Physicians will need to specify the site of the non–excisional debridement

2. Be up to date with the latest Coding Clinic advice – it is more important than ever, for example:
   • Changes in definition: Recent Coding Clinics redefined the definition and application of 7th character – Episode of Care codes
   • Advice on how to code procedures (which is brand new to everyone)
   • New guidance on how to code common diagnoses (for example, documentation of weakness due to stroke can now be coded as hemiparesis)

3. Be aware of brand new diagnostic terms with ICD-10
   • For example, in traumatic brain herniation, “traumatic” is a new descriptor with ICD-10. Traumatic herniation of the brain due to a subdural hematoma is included in the subdural hematoma ICD-10 code S06.2X0A. A new code, for traumatic cerebral edema S06.1X0A was created and is used as an additional code with traumatic subdural hematoma. This additional code provides a MCC.

4. Familiarize yourself with conditions that effectively act as a “comorbid condition” or “CC”
   • For example, Code 20 (diverticulitis of large intestine with perforation or abscess without  bleed) is a  diagnosis code that acts as its own “CC” for DRG 330 (Major small and large bowel procedures with CC)

In addition to the recommendations above we also suggest continued audits to improve coding accuracy, compliance, DRG reimbursement opportunities and to identify areas of improvement for your HIM department.  What are some of the top trends your department has identified in ICD-10 coding practices?  Send us a note at contact@providentedge.com.