3/28/2016 1 1 PHYSICIAN DOCUMENTATION IMPROVEMENT For ICD-10-CM Presented by: Marian J. Wymore, MD, CPC All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and may not be reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC. Objectives: Physician Documentation Improvement for ICD-10-CM 2 Learn the importance of physician documentation improvement on accurate and precise ICD-10-CM coding. Develop a greater understanding of the change in verbiage necessary for physicians to use. Suggestions on how to educate your physicians on how to include this terminology. Understand why improved clinical documentation improves quality, more appropriate reimbursement, and more timely payment. Relationship between accurate and precise documentation, ICM-10 codes, risk adjustment, and STARS measures.
26
Embed
PHYSICIAN DOCUMENTATION IMPROVEMENT...3/28/2016 1 1 PHYSICIAN DOCUMENTATION IMPROVEMENT For ICD-10-CM Presented by: Marian J. Wymore, MD, CPC All information contained herein is the
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
3/28/2016
1
1
PHYSICIAN
DOCUMENTATION
IMPROVEMENT
For ICD-10-CM
Presented by:
Marian J. Wymore, MD, CPC
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD,
CPC and may not be reproduced, published or distributed to, or for, any third parties without the express
prior written consent of Marian J. Wymore, MD,CPC.
Objectives: Physician Documentation
Improvement for ICD-10-CM
2
Learn the importance of physician documentation
improvement on accurate and precise ICD-10-CM
coding.
Develop a greater understanding of the change in
verbiage necessary for physicians to use.
Suggestions on how to educate your physicians on how
to include this terminology.
Understand why improved clinical documentation
improves quality, more appropriate reimbursement,
and more timely payment.
Relationship between accurate and precise
documentation, ICM-10 codes, risk adjustment,
and STARS measures.
3/28/2016
2
Where To Begin
3
1. Understanding resistance to change:
busy schedules, probably inadequate sleep,
possible overwhelm or burnout
2. Ask for providers’ input and identify leadership
3. Establish relationship of mutual respect
4. What’s in it for me? Quantify potential financial incentives
5. Educational programs that work with providers’ schedules
or STARS. Clarify “family of codes”, 3-7 characters of
ICD-10 codes, current HCCs, amount of
documentation necessary for active problems, define
“quality” “STARS” & goal of 5
2. Educate providers to expand clinical thinking to
include improved documentation specificity for ICD-
10-CM, risk adjustment, and STARS. Providers
appreciate consolidation of trainings.
3. Provide tools to improve documentation and
capture HCCs.
4. Facilitate provider efforts to fulfill on quality
measures.
3/28/2016
3
ICD-10 Documentation Specificity
and HCCs
5
• Providers may find the additional verbiage for detailed
diagnostic coding choices in ICD-10-CM time consuming
initially.
• Educate physicians in specific documentation verbiage
for most common diagnoses, and how to efficiently find
codes under ICD-10 for conditions not often encountered.
• Look for trends in decreases in capture rate for HCCs
that may occur from insufficient documentation and use
of “without complications” or unspecified codes.
• Documentation to specificity level of family of codes only
may be insufficient to capture HCC (even if Medicare
lenient until Oct. 1, 2016.)
Clinical Documentation
Improvement for Providers
5 Questions to ask yourself to improve documentation of
patient encounter:
SADSS
6
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be
reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
3/28/2016
4
7
SADSS
S: Can I be more Specific?
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be
reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
8
SADSS
A: Acuity/Chronicity
Document if problem is:
Acute? Chronic? Acute on chronic?
PMH (past medical history) vs. active/under treatment?
Affecting care of current condition?
Why on meds?
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be reproduced,
published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
3/28/2016
5
SADSS
D: Is the diagnosis Due to coexisting/comorbid condition?
Document cause and effect
Lots of combination codes in ICD-10
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
9
SADSSS: Does medical record Support dx?
history
physical findings
assessment
treatment plan
medication
current year? HCC-Risk Adjustment
Example: hemiparesis
Update EMR
Not sufficient to code a more specific diagnosis without chart documentation to back it up
10
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be
reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
3/28/2016
6
SADSSEMR: Support Diagnosis
Patient Problem list and PMH often extensive and
automatically regenerated in new progress note.
Many listed diagnoses are not addressed on DOS, and may appear to be PMH.
Providers should document any active conditions assessed at
time of service /at least once per year for HCCs.
Document:
Any Associated Diagnoses or Conditions
that are under treatment
And/or
That are affecting care of current condition,
decision making, treatment or management
Update medical record with any additional or more specific diagnoses
from ER, inpatient, specialist, or other provider visits since last DOS. 11
SADSSProvider should Document:
Any Associated Diagnoses or Conditions that are under
treatment
And/or
That are affecting care of current condition, decision
making, treatment or management
Includes:
all acute and chronic medical conditions
complications
manifestations
mental, behavioral, neurologic, or congenital disorders
obstetric, dermatologic, musculoskeletal dx
injuries or poisonings
substance abuse
infections
signs & sx (if primary dx not known)
12
3/28/2016
7
SADSSS: Any quality measures to address?
STARSWeighted x1:
Breast/colorectal screening
Annual flu shot
Assess:
physical activity
BMI
functional status
pain
medication review (document condition being treated)
13
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be
reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
SADSSSTARS Measures
Weighted x3:
Review high risk meds:
Consider adjustment? Elimination? Substitution?
Document diagnosis, treatment plan, and justification
Document drug dependency eg. opiates/sedative-hypnotics
Reference:
American Geriatrics Society
BEERS Criteria for potentially inappropriate medication use
Med compliance- diabetes/HTN/statins
Control- blood sugar/blood pressure
Improving/maintaining- mental and physical health
Plan for all cause readmission
14
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be
reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
3/28/2016
8
SADSS
STARS MeasuresWeighted x1.5
patient reported outcomes
patient satisfaction
15
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be
reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
ICD-10 Documentation, HCCs
and STARS Measures
16
When providers document diagnoses to the highest level of
specificity, and capture all appropriate HCCs, there will be
more STARS measures to fulfill on.
Examples:
Type 2 Diabetes Mellitus
Rheumatoid Arthritis
Educate providers on actionable STARS measures and support
their efforts to help patients realize these goals.
Important to maintain STARS ratings of 3.5 or greater, optimally
4.5 to 5.
Medicare is emphasizing quality care and will continue raise
the bar.
Inadequate STARS ratings will jeopardize contracts.
3/28/2016
9
Positive Reinforcement
17
1. Respect and acknowledgment for actions taken by
providers/results
2. Share data often
3. Competition: comparison with self, peers, ratings
4. Financial incentives
5. Emphasize quality/providers want to do a good job
6. Satisfaction with work/well being
7. Support
Peer Pressure
If Severity of Illness (SOI) is inadequately
documented by provider:
Morbidity & mortality will appear excessive
Quality will appear low
Risk Adjustment payments will not reflect
the costs associated with the treatment and
management of the sicker patients
Show physicians data on how they
stack up against others
(and what data is publically available…)
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be
reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
18
3/28/2016
10
Clinical Documentation
Improvement for ICD-10-CM
All diagnoses must be precisely documented by
providers
Provide available detail for coding highest number of
characters (3 to 7)
Avoid using unspecified codes or symptoms
Update medical record when more specific
diagnosis made. Refer to specialists’ consultation
reports when available.
19
All information contained herein is the confidential and proprietary property of Marian J. Wymore, MD, CPC and/or ICodify and may not be
reproduced, published or distributed to, or for, any third parties without the express prior written consent of Marian J. Wymore, MD,CPC.
GEMs/Crosswalks
Were not designed to simply translate codes ICD-9 to ICD-10
“The GEMs are not a substitute for learning how to use ICD-10-CM
and ICD-10-PCS.”
“In coding individual claims, it will be more efficient and
accurate to work from the medical record documentation and
then select the appropriate code(s) from the coding book or
encoder system.”
“The GEMs are a tool to assist with converting larger ICD-9-CM