Guest Post: Wrapping your CDI arms around ICD-10-CM/PCS
by Karen Newhouser, RN, BSN, CCDS, CCS, CCM
ICD-10 CM/PCS. To some, the utterance of this classification system produces much trepidation. I hope to dispel some concerns as I recount the undertaking of ICD-10 implementation at one CDI program.
First, please understand that I am not here to de-emphasize the seriousness of ICD-10-CM/PCS, but rather to equip you with a roadmap of tips and hints as you embark on this journey.
Yes, CDI specialists’ productivity will likely decrease, mostly due to the sheer volume of queries needed for the added specificity vital for correct code assignment. The act of query writing, no matter how experienced one may be, takes time. I feel, though, that with preparation and open channels of communication, the impact on productivity can be assuaged, however.
This case example CDI program is housed within the HIM department of a large Midwestern hospitalthat holds national ranking as a U.S. News and World Report Best Hospital. The CDI team is comprised of 25 CDI specialists who work on the units and four documentation quality coordinators (DQCs), who serve as second level reviewers. The unit CDI specialists have assigned units, which helps with relationship building and continuity. The entire team is comprised of consultants with MedPartners CDI, and the success of this team is built on the relationships with the clinical care team they cultivate, as well as their knowledge and expertise. The focus of the CDI team is holistic, meaning that the goal is a complete and precise narrative of the patient encounter documented by the provider in the medical record.
The facility’s ICD-10 implementation began in early 2013, with the integration of queries that incorporated the specific documentation necessary for code assignment in ICD-10-CM. This served two purposes as it began to:
- Introduce the necessary elements to the CDI team
- Assimilate the necessary specificity for the providers
The end goal for this initiative was that October 1st, 20XX would be just another day to the providers in the hospital setting.
March 19, 2014, the facility we live with ICD-10 code assignment using the 3M CDIS tool. While the initial plan was to dual code (both ICD-9 and ICD-10); in the end, a decision was made to have the CDI team work solely within the ICD-10-CM/PCS environment. On “go-live” day the team met to emphasize the effort as a time of learning, growth and discovery—with the expectation that productivity would drop. The team understood that it was more important that they learn and assist each other as they ventured down this road together.
Questions were channeled through a command center, manned by the DQCs, who immediately analyzed the scenario, closed the loop with the CDI specialists and compiled the questions and answers and posted them on the CDI Team Share Drive. Weekly “huddles” were held to discuss everything ICD-10, from how to navigate the encoder and use the online code book, to query formation and the enhancement of query templates.
It should be mentioned that the CDI team worked mostly in ICD-10-CM, with overall limited exposure to ICD-10-PCS. The CDI team would code the procedure if they had the full report, but the availability of these reports was limited to longer stay surgical cases and in critical care units.
A study of before and after implementation data showed a minimal impact on CDI productivity, with an expected slight drop initially, and a rapid rebound to pre-implementation productivity numbers.
My hope is that I have provided you with encouragement that ICD-10-CM/PCS doesn’t have to be met with apprehension. I don’t profess to know all of the answers regarding ICD-10, but we can all appreciate the journey and grow as we open the channels of communication.
Let us grow together.
Editor’s Note: Newhouser, at the time of this article's release, was the director of CDI education for MedPartners HIM.