Donna: Hey Sue, I am getting questions regarding Clinical Documentation Improvement (CDI) staff involvement in ICD-10 implementation.
Sue: Hopefully the CDI staff will be involved in the enterprise wide ICD-10 education, allowing them to fully understand the documentation changes needed to support ICD-10 as well as what stays the same. They’ll be on the front lines educating the physicians on I-10.
Donna: That’s true, along with generating queries for additional documentation. I see them starting to query as soon as possible for some of the specificity needed to minimize the query overload that is anticipated after October 2014.
Sue: They can pick a few diagnoses to start with and then gradually add more – you know, kind of easing themselves as well as the physicians into I-10. Take for example the diagnosis of respiratory failure. In ICD-9, the diagnosis of “respiratory failure” defaulted to the code for acute respiratory failure. In ICD-10 that won’t be the case – it will default to an unspecified respiratory failure code. So, today, when the CDI staff sees a diagnosis of unspecified respiratory failure, they can work on clarifying whether it is acute, chronic, or acute-on-chronic. Oh, and now in ICD-10, respiratory failure is further specified as being “with hypoxia” or “with hypercapnia.”
Donna: You’re correct. I think this type of query could be introduced without calling it out as an ICD-10 concept. I call this “passive education.”
Sue: Great idea! Bringing attention to it as an ICD-10 concept will only cause additional negative discussions.
Donna: This is the time for a staff member with excellent knowledge of ICD-10 specificity to revise the current query templates to ensure that all are using ICD-10 terminology. As an example, debridement in ICD-10 is identified by root operation and body part. The body parts are different in ICD-10 and are divided into skin, subcutaneous tissue, fascia, muscle, and bone. In ICD-9 skin and subcutaneous tissue fall under one category.
Sue: I have heard that the transition to I-10 would cause productivity loss for CDI specialists as well as an increase in queries by 40%. That seems extreme!! What do you think??
Donna: Well I think those two things could be mitigated depending on the pre-work that is done.
Sue: What do you mean, pre-work?
Donna: For example, if the facility determines that a physician is not including the contrast agent used during an angiography procedure in his or her procedure note, that could be fixed now instead of in October 2014. I mean, really, who wants to take time to query physicians to obtain documentation of a contrast agent?
Sue: I totally agree -
Donna: And another thing, everyone should take a look at how well their medical staff is performing at responding to queries today in ICD-9. If the response rate is not good, they should try to remedy that now because they are going to need to really insure physician response once the transition to ICD-10 occurs.
Sue: It seems that CDI staff have a lot of preparation that needs to be done prior to October 2014. I think the motto is “Why wait – start now.”
Sue Belley is a Project Manager with the Consulting Services business of 3M Health Information Systems.
Donna Smith is a Project Manager with the Consulting Services business of 3M Health Information Systems.