Two groups of professionals took the field at roughly the same time last month in Baltimore: the Orioles faced off against the Toronto Blue Jays while the American Health Information Management Association (AHIMA) “Crusaders” tackled a few ICD-10/CDI curveballs.

As in baseball, statistics were analyzed, key players were reviewed, and strategy was discussed. The only difference between the two lies in the challenges presented – and in our case, we all have a chance to win if we’re prepared for ICD-10 and errors are kept to a minimum.

One of the most critical issues discussed among health information management (HIM) professionals attending AHIMA’s ICD-10-CM/PCS and Computer-Assisted Coding (CAC) Summit was the need to bolster clinical documentation improvement (CDI) programs in advance of the transition to ICD-10. Two key facts offering challenges were identified:

  • There will be an inevitable boost in the number of physician queries.
  • Hospitals will need more clinical documentation improvement specialists (CDISs).

To address these challenges, Lisa Knowles (RHIT, CCS) from Cleveland Clinic suggested the following strategies.

Manage Physician Expectations as Query Volumes Rise

First and foremost, physicians will see more clinical queries from both CDISs and coders in ICD-10. Such increases are inevitable due to ICD-10’s enhanced granularity and specificity. In the case of the Cleveland Clinic, a recent study revealed that query volumes were projected to double. To cope, organizations are advised to begin setting and managing physician expectations. The move to ICD-10 requires changes in clinical documentation, but the primary driver for improvement is clinical specificity.

Improved documentation through enhanced clinical specificity leads to higher reported quality ratings, better patient outcomes and more-informed clinical treatment and follow-up. The accuracy of clinical data is more important than ever. Specific tactics to prepare physicians for a boost in their number of queries include:

  • Work specialty-by-specialty to incorporate ICD-10 terms into physician queries now.
  • Change one form of query per month to transition documentation slowly over time.
  • Educate physicians and provide documentation tip sheets.
  • Pay special attention to “outliers,” the physicians who continue to push back on queries in ICD-9.

Hire More Clinical Documentation Specialists

It is a fact, again, that more clinical documentation specialists will be needed under ICD-10. TrustHCS recommends one CDIS for every 100 hospital beds. At Johns Hopkins Hospital in Baltimore, there is one CDIS for every 50 inpatient beds. For every CDIS on staff, hospitals can expect a $1 million reimbursement boost as the specialists work diligently to identify query opportunities and improve coders’ ability to capture CCs and MCCs.

Speakers at the recent summit also agreed that CDIS productivity is bolstered by using computer-assisted coding (CAC) systems. At Cleveland Clinic, CAC integrates and strengthens existing coding and CDI programs, and it also assists in the review of the vast amounts of text within the EMR. Furthermore, it enables CDISs to search for terms based on clinical data while highlighting new documentation in progress notes. An important note: CAC will have the greatest impact on organizations with robust EMRs already in place and existing compliant, responsive provider populations. Providers who don’t have these critical elements in place likely will find themselves questioning their investment.

According to a TrustHCS/AHIMA research project presented at the summit, 75 percent of hospitals surveyed expect to have CAC in place by 2015. However, it is the combination of CAC, CDI and manual coding that will best support a successful ICD-10 transition and become part of best practices in years to come.

Get with the Program

Sixty-six percent of hospitals recently surveyed already have CDI programs in place, and 41 percent of hospitals without a program now plan to start one sometime in 2013.[i] The move to ICD-10 will be a manageable change for these facilities, but those without CDI programs may be facing a frightening scenario. Now is the time for hospitals to get into the ICD-10 game, and while doing so, cover every one of their CDI bases.

About the Author

Torrey Barnhouse is the founder and president of TrustHCS, a firm dedicated to serving the coding, auditing, ICD-10 preparation, clinical documentation, and revenue integrity needs of healthcare organizations. Currently, Torrey serves on the American Health Information Management Association (AHIMA) Foundation Board and the Remington College HIM National Advisory Board. He is a regular contributor to the Coding Compliance Blog, the Health Information Management Association, For the Record, and many other publications. He is a national speaker and author on a number of industry-related topics and holds a bachelor’s degree in psychology from Abilene Christian University.

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[i] “The State of H.I.M.: A Study of the Impact of ICD-10, CDI and CAC Initiatives within the Health Information Management Community:” TrustHCS and AHIMA Foundation. April 2013. Available online at

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