Amidst all of the discussion surrounding ICD-10 implementation, much attention has been paid to the practical discussion surrounding the need for a more anatomical understanding of the diagnosis and/or procedure assignment and its impact on clinical documentation and the HIM coding community.
CMS has posted the GEMs mapping for years now, and there has been an industry emphasis on ‘financial neutrality’. From a financial perspective, uncertainty is bad and volatility is bad.
Financial neutrality can only be feasible with a direct mapping from one code set to another, whereby you can assure this neutrality.
The nature of ICD-10 coding is such that with greater specificity in documentation, different coding patterns may evolve. There is no shortcut to the need to manage the migration.
As we live with the rollout of ICD-10 implementation, let’s all be aware that a new game is in town.
Remembering that the impact of coding assignment lies not just in DRG/APC/prospective methodology, but perhaps just as important, in determining medical necessity.
Medical necessity denials have always been a problematic area, and subject to evolving diagnostic standards, but the magnitude of that potential volatility is multiplied with the greater level of specificity introduced with ICD-10.
We will all need to keep a close eye on our denial patterns, reimbursement patterns, clinical pathways to understand how the adoption of a more anatomically specific coding system is impacting both our clinical operations as well as our revenue cycle.
Let’s enjoy the ride while we keep a close eye on our KPIs.