1. Physician CDI Preparation for ICD-10
Timothy N. Brundage, MD, CCDS
Certified Clinical Documentation Specialist
Physician CDI Preparation for ICD-10

2. Clinical Documentation Integrity Program:
“We do not believe there is anything inappropriate, unethical, or otherwise wrong with hospitals taking full advantage of coding opportunities to maximize Medicare payment that is supported by documentation in the medical record.”
CMS 2008 IPPS Final Rule, FC.pdf, page 208

3. Why does CDI Matter?
Utilization
Quality
Medical legal
Reimbursement
Clinical
Medicine
Medical
Record
Physician
Profiles
&
Hospital
Report
Cards
Data Coded
Physician documentation in the medical record is an important instrument in the economics of healthcare

4. Why does CDI Matter? Medicine Under The Microscope
Cost per patient
Resource utilization
Length of stay
Complication Rates
Morbidity Scores
Mortality Scores
Outcome Analysis
Audits

5. In this World of Documentation
Documentation reflects severity of illness (SOI) and risk of mortality (ROM) scores.
Specificity is vital, a definitive diagnosis must be documented.
Physician profiles are developed from documented information
Golden Rule: “If it is not written in coding language, it didn’t happen”

6. ICD Versions ICD-9 ICD-10 ICD-11 1977 – Worldwide use
1979 – U.S. modification
Clinical & mortality
ICD-10
1994 – Release of full ICD-10 by WHO
Published in 42 languages
1999 – Adopted for death certificates in the United States
Mortality
2014 – U.S. modification
Clinical
ICD-11
2015 – Tentative rollout worldwide

7. Differences Between ICD-9-CM and ICD-10-CM/PCS
ICD-9-CM diagnosis
3–5 characters
Allows for 1 letter (1st position); otherwise numeric
ICD-9-CM procedures
4 characters only
All characters are numeric
ICD-10-CM
3 to 7 characters
1st character is alpha (except U); others are either alpha or numeric
Numbers 0–9; letters A–H, J–N, P–Z
Alpha characters are not case-sensitive
ICD-10-PCS
Same as ICD-10-CM except each code must have 7 characters
Letter “Z” used as a placeholder

8. ICD-9-CM Structure – Format
Numeric or alpha
(E or V)
Numeric 5 E V 4 X 1 X 4 X . . X X
Category
Etiology, anatomic
site, manifestation
3–5 characters 8

9. ICD-10-CM Structure – Format
Additional characters
Alpha
(except U)
2–7 numeric or alpha . . M S A X 3 X X 2 X 1 X X X A
Category
Etiology, anatomic
site, severity
Added code extensions (7th character) for obstetrics, injuries, and external causes of injury
3–7 characters

10. Physician Buy In to CDI
The most challenging aspect of CDI How do you motivate physicians to educate themselves?

11. Teach Physicians about Quality Data
Without all diagnoses documented, profiles will inappropriately reflect higher than expected mortality
Complete documentation, reflective of the true severity of illness of patients will justify outcomes
Profiles are used for both commercial and public use
Future reimbursement methods will likely incorporate profiles in the formula (e.g., pay for performance) 11

12. Physician Profiling Hospital Report cards
Healthgrades, Delta Group, Leapfrog
Medicare Physician Data (since 2007)
Federal and state regulatory agencies (e.g. OIG)
The Joint Commission (TJC)
Centers for Medicare and Medicaid Services (CMS)
Quality Improvement Organizations (QIO)

13. Healthgrades.com

15. Physician Quality Ratings
Predicted Mortality Rates for some disease processes in this case:
Community Acquired Pneumonia = 10%
Sepsis = 30%
Septic shock = 50%
If the patient survives, quality ratings will be much higher in the public reporting data because the physician took care of a “sicker” patient.
Expected mortality will be higher than actual mortality.

16. ICD-10 Physician Education
Don’t need to turn doctors into coders
Need good documentation habits
Need specialty specific documentation education
Begin the process of education now for ICD-9 and incorporate ICD-10 issues into the education

17. Questions? Email DrBrundage@Gmail.com