According to a survey of 650 hospital technology and physician leaders published in July 2014 by Black Book, hospitals are increasingly undertaking clinical documentation improvement initiatives in the wake of ICD-10 implementation due on October 1, 2015 and they are relying on outsourcing for that. The survey says the initiatives give the signs that the number of hospitals contracting external services for improving documentation will increase threefold before the implementation deadline. It also says if 24 percent of hospitals now outsource clinical documentation, audit, review and programming, 71 percent of hospitals plan on partnering with an external documentation improvement service by Q3 2015 to help them survive under the new coding system.
It is expected that healthcare providers may face a drop in revenue following the ICD-10 implementation owing to the delay in transitioning to the new codes. By improving the accuracy of documentation at the earliest, healthcare providers can maximize their financial health and this is a major reason why they choose outsourcing. As per the survey, around 88 percent of 200+ bed hospitals outsourcing documentation improvement initiatives were reported to find significant gains in their revenue and receive proper reimbursement with the improvement programs even before the ICD-10 implementation. The survey also found the transcription services currently utilized by 63 percent of hospitals would be used by more than 70 percent of providers as the deadline approaches.
Another major challenge that arises when transitioning to ICD-10-based documentation is the presence of more specific codes. Let’s take the case of atrial fibrillation, the most common abnormal heart rhythm. There is only a single code for this condition in the ICD-9 coding system (427.31). But, we can find four different cases in the ICD-10 system such as:Paroxysmal Atrial fibrillation (I48.0)
- Persistent Atrial fibrillation (I48.1)
- Chronic Atrial fibrillation (I48.2)
- Unspecified Atrial fibrillation (I48.91)
So, the relevant documentation should contain each and every detail of the patient’s condition in order to use the appropriate ICD-10 code for atrial fibrillation. Preparing such kind of specific documentation is a tiresome task for physicians and it requires a great deal of time to complete the transition.
On the other hand, external agencies are well-equipped with experienced medical coders and efficient resources to help providers create complete documentation that supports the specificity required for ICD-10 codes and save considerable time. If they find that the documentation is incomplete or spots any discrepancy, they will ask for more details from the physicians and ensure legibility, completeness, clarity, consistency and precision in the documentation. With this comprehensive approach, they can fulfill the documentation requirements necessary for ICD-10.
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