1. AMDIS Documentation Panel

2. ICD-10 Impact
Coder
Productivity
Physician
Productivity
Rework
Change in Charts
Coded per Hour
3-12 Mos. post
transition
Long Term
Increase in Queries
DNFB / DNFC
Increase in Inquiries,
Claims Adjustments
& Rejections
-5% to -
10%*
Coder: -20%
• Inpatient: ~5 charts/day
• Outpatient: ~8 charts/day
• ER: ~24 charts/day
Coding Manager:
-35% to -50%
-10% to -20%
+45 to +90 min/day -10% to -25%
Source: Advisory Board Research & Analysis,
recent Precyse customer data

3. ICD-10-CM Impact
ICD-10-CM is manageable as the documentation
impacts fall in 8 to 10 core impact areas:
 Axis of Classification
 Possible 7-digit codes
 Laterality
 Trimester Specificity
 Drug and Alcohol Code Expansion
 7th Digit Expansion Codes
 Complication Codes
 Combination Codes
 Increased Specificity

4. An Example of Impact
 ICD-10 often combines disease specificity, common
sites/locations, and manifestations of the disease into
one code
 Non-specific documentation (such as Regional
Enteritis) will result in significant increases in queries
and increases in denials
Regional enteritis of
the large intestine
Unspecified
intestinal
obstruction 560.9
555.1 K50.112
Crohn’s Disease of
the large intestine
with intestinal
obstruction

5. An Example of Impact
ICD-10-CM is a much more clinically-based system
Allows physicians to truly show severity of a
patient’s illness
ICD-9-CM ICD-10-CM
455.- 10 Hemorrhoid codes
• External
• Internal
• Unspecified
K64.- 8 Hemorrhoid codes
• Degree of severity
(First to Fourth)

6. ICD-10-PCS Impact
 All diagnostic information is excluded
 Standardized and self-contained (No Latin, terms have one
definition, etc)
 No more Eponyms
 No more unspecified procedures
 Will require use by coders of far more specific anatomical and
pathophysiological concepts

7. The Big ‘Holes’ to Fill
 Avoiding umbrella/non-specific codes
 Specific documentation of underlying conditions
and manifestations
 ICD-10 ready templates/prompts
 Telling the ‘whole’ clinical story
 Drive severity of illness/medical necessity

8. ICD-10 Training to Ready
Documentation

9. • Determine severity of illness and prove medical necessity.
• Grow compensation and reimbursement.
• Address technology and healthcare reform initiatives.
• Ensure strong reputation.
- Physician profiling/national registries
- Quality reporting
- Consumer health sites
• Avoid the risk of audits.
How to ‘Sell’ the ICD-10 Message?

10. The ICD-10 Tree
 ICD-10 is similar to a tree
Physicians
Ancillary Departments
Coders
Finance
HIM
IT/IS

11. Best Practices: Get Physician Buy-In
 Make it practical
 Make it convenient and mobile
 Use a combination approach eLearning,
peer-to-peer, and internal programs
 Communicate the ‘What’s In It For Me’
effectively

12. Best Practices: Tiger Team
 Create a Tiger Team that takes the education
before everyone else
 Allows you to develop ‘super users’ who will be
able to help others, answer questions, and
provide potential training
 Comprised of individuals from all major
education groups, such as coders, CDIS,
physicians, and others

13. Best Practices: Collaborate with CDIS
 View the Clinical Documentation Improvement
Specialist role as the most critical to success
 Use them as your ‘champion’ to:
• Do face-to-face education
• Integrate documentation education into current
practices
• Rework queries/forms
• Develop additional education collateral and printable
documents

14. Best Practices:
Strong Communication Plan
 Essential to look at ICD-10 as an Education and
Communication event
 Should try to use:
 Posters/Collaterals for awareness
 E-mail Blasts
 Organization Newsletters
 Mailbox Stuffers
 Organization Webinars
 ICD-10 Website on Intranet