Introducing your outpatient departments to CDI

As a result of the delay, however, providers have been able to spend more time fine-tuning their ICD-10-CM training, both for coders and physicians. The unanticipated delay also added time for providers to consider adding clinical document improvement (CDI) specialists in outpatient departments to help ease the transition while also improving ICD-9-CM coding accuracy.

 

CDI specialists typically review inpatient records to obtain specificity related to principal and secondary diagnosis. As a profession, such staff combine clinical knowledge with coding, billing, and documentation experience. Although not as prevalent as inpatient efforts, outpatient CDI is a growing trend.  

 

With the increased need for specificity associated with ICD-10-CM and other regulatory changes, more facilities are considering implementing outpatient CDI programs, according to Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA, AHIMA-approved ICD-10 CM/PCS trainer, a senior consultant for Nuance Communications in Dunwoody, Georgia.

 

An outpatient CDI program should be aligned with a facility's ICD-10-CM initiatives, according to King, since both require a focus on coding and documentation. Payers may also be changing their policies regarding ICD-10-CM, which could require reporting much more accurate diagnoses.

 

"In I-9, [payers] covered a lot of unspecific diagnoses, [but] they are saying no in ICD-10," King said. "Their reasoning is that with the availability of more specificity, an unspecific code could be reflective of either fraud or poor patient care."

 

For example, while current documentation for reporting asthma in ICD-9-CM may be sufficient, ICD-10-CM requires terms such as "mild intermittent," "exacerbation," or "with status asthmaticus" to be included in order to report the most specific code.

 

An outpatient CDI program will also be able to target areas of incomplete and insufficient documentation, such as infusion start and stop times or date of service errors.

 

A key driver for outpatient CDI efforts is denials, according to King. The top reasons claims are denied on the outpatient side include incomplete or insufficient documentation, medically unnecessary treatment, and incorrect coding. A CDI program will be able to mitigate denials from each of those categories.

 

CDI specialists can also assist in ensuring claims include medically necessary diagnoses, according to National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

 

For example, CPT code 77080 (dual-energy X-ray absorptiometry [DXA], bone density study, one or more sites; axial skeleton [e.g., hips, pelvis, spine]) requires the documentation to support specific ICD-9-CM codes in order to avoid denials.

 

According to the NCD, claims submitted with 77080 must include one of the following diagnosis codes:

"[Payers] have very straightforward rules," King said. "It's just challenging at times to keep up with what those are and making sure that you comply."