A hard look at ICD-10 specificity

October 5th, 2016

In our previous blog, we posed a series of questions that AHIMA convention goers might wish to consider while at the event. They included: “Is my organization’s ICD-10 coding consistently accurate?”

In retrospect, we should have added: “Have we achieved the specificity required?”

That’s because, as CMS has advised, there’s a difference between a “correct” code and a “valid” one, a concept given impetus as the program’s grace period ended October 1. Now, the leniency in the specificity of codes extended to providers will cease.

While many providers are where they need to be on coding specificity, those who are not can logically expect more audits and claims denials. They also will be falling short on the promise of ICD-10 to improve healthcare through more finely tuned patient information.

In this regard, a recent article in Medical Economics offered five tips to help providers avoid undue financial burden and find the right method for implementing ICD-10 in a medical practice in this stricter environment. These tips addressed specificity, accuracy, communication, practice and vigilance.

We would add a sixth: Appropriate training for all involved, including physicians, that incorporates ongoing changes, strengthens skills and creates understanding through context.

ICD-10 is not going to get any easier. And as new and different codes come on board and leniency in specificity goes away, it could, however, become harder.

It’s important for providers to understand this reality and assure their staffs are positioned to succeed – both for the organization and the patients they serve.