Increasing Revenue and Planning for ICD-10: How Clinical Documentation Improvement Accomplishes Both


Clinical documentation improvement has become a tried-and-true strategy for hospital finance executives to shore up their revenue cycle, and with ICD-10 going live in roughly one year, its importance is becoming magnified.

In essence, CDI programs are those in which clinicians and health information management professionals work together to increase coding accuracy and appropriately depict the level of services delivered. Strong CDI usually leads to increased revenue for hospitals because they are appropriately recording the care they provided. Prior to a CDI initiative, this revenue likely fell through the cracks unnoticed.

"Clinical documentation is going to be even more important with ICD-10, as documentation from doctors on the floor will have to support the correct DRG," says Tim Jodway, CFO of Garden City (Mich.) Hospital. "This involves some software and a lot of training. The CDI nurses want doctors to document [their] thinking."

Mel Tully, senior vice president of clinical service and education at technology firm Nuance, adds that CDI programs are vital for hospitals because no one knows the true financial impact of the transition from ICD-9 to ICD-10.

Here are three tasks hospital financial and HIM departments should focus on over the course of the following year to ensure they have a strong CDI program for the switch to ICD-10.

1. Get CDI in order. Hospitals cannot put the cart before the horse when it comes to ICD-10, Ms. Tully says. First, finance and HIM executives have to make sure what they are doing now — proper documentation and compliant coding — is at an optimal level.

"If you have lousy documentation for ICD-9 and your case mix index isn't where it should be, odds are it'll be even worse in ICD-10," Ms. Tully says. "The granularity and specific codes within ICD-10 will determine part of reimbursement, so have the right documentation specialists in place. And make sure physicians are already on board and responsive to your ICD-10 specifications."

2. Look at the top 20 DRGs and procedural codes. Finding out the procedures that dominate a hospital's cash flow is good area to start in terms of improving CDI and coding over ICD-9 to ICD-10, Ms. Tully says. Since these areas represent such a large chunk of the hospital's revenue, they naturally are a high-priority area.

However, Ed Hock, a senior director at The Advisory Board Company, says hospitals must go one step further. They must also find out which codes need improved documentation. This goes beyond just the high-volume codes. For instance, malignant neoplasms are not usually within the top 20 of most frequently coded procedures, but the number of malignant neoplasm codes will more than double from ICD-9 to ICD-10. "There are tons of new documentation concepts with this," Mr. Hock says. "And if physicians don't get those concepts right, there will be significantly lower reimbursements or significant amounts of denials."

3. Start ICD-10 clarifications and queries now. ICD-10 may still be a year away — but it's only a year away. Time is relative, and hospitals need to start acting as if ICD-10 is around the corner, Ms. Tully of Nuance says. This means CDI specialists must be querying physicians on what their documentation says and asking physicians for additional documentation. These types of processes are the difference between peace of mind and millions of dollars in lost revenue, not to mention potential audits from government contractors, Ms. Tully says.

Starting a robust CDI initiative, conducting internal research on procedural codes and proper training are all necessary steps hospitals should take before the ICD-10 deadline takes effect. And in the end, it takes a team effort from CDI specialists, revenue cycle staff, hospital executives and, especially, physicians to reach this level of clinical documentation success. Revenue is on the line, Ms. Tully adds, and in an era where revenue is progressively getting harder to come by, simple measures like CDI can give hospitals a competitive edge.

More Articles on CDI and ICD-10:
Preparing for ICD-10 Requires Leadership, Communication of Benefits
4 Areas Where Better Documentation Can Improve Hospital Revenue
ICD-10 or ICD-11? The Dilemma Behind Both Coding Systems

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