An Evaluation of the ICD-10-CM System: Documentation Specificity, Reimbursement, and Methods for Improvementud(International Classification of Diseases; 10th Revision; Clinical Modification)ud

摘要

The research project consists of three studies to identify the documentation specificity, reimbursement and documentation improvement for the upcoming International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system. A descriptive research study using quantitative methods was conducted for the first study, which focused on coding electronic documents across each major diagnostic chapter for ICD-10-CM. The coding was ranked according to the Watzlaf et al (2007) study where a ranking score was provided if the diagnosis was fully captured by the ICD-10-CM code sets. The ICD-10-CM codes were then compared to the current ICD-9-CM codes to evaluate the details on the descriptions of the codes. The rankings were determined by comparing the ICD-10-CM systems for the number of codes, the level of specificity and the ability of the code description to fully capture the diagnostic term based on the resources available at the time of coding. ududA descriptive research study using quantitative methods was conducted for the second study, which focused on evaluating the reimbursement differences in coding with ICD-10- CM with and without the supporting documentation. Reimbursement amounts or the MS-DRG (Medicare Severity Diagnosis Related Groups) weight differences were examined to demonstrate the amount of dollars lost due to incomplete documentation. Reimbursement amounts were calculated by running the code set on the CMS ICD-10 grouper. ududAn exploratory descriptive research study using qualitative methods was conducted for the third study which focused on developing a documentation improvement toolkit for providers and technology experts to guide them towards an accurate selection of codes. Furthermore a quick reference checklist geared towards the physician, coders and the information technology development team was developed based on their feedback and documentation needs.ududThe results of the studies highlighted the clinical areas which needed the most documentation attention in order to accurately code in ICD-10-CM and the associated potential loss of revenue due to absent documentation. Further, the results from the educational tool kit could be used in the development of a better inpatient Computer Assisted Coding (CAC) product.ud