How Accurate is Your Diagnosis Reporting?

Time to Focus on the Importance of ICD10CM Quality.

As you are preparing for your 2023 production data to be analyzed, don’t forget about the importance of accurate ICD10CM reporting. It’s been common knowledge for years that ICD10 codes represent medical necessity for services provided to patients, however, quality reporting has only recently started to gain significant traction. Not only have we noticed an uptick in payers down-coding E/M services based solely on the diagnosis(es) reported, but we have also seen an increased emphasis from managed care organizations (MCO’s) rolling out incentivized programs for improved quality data for chronic conditions. Some clinics have seen as much as $150 per closed risk gap associated with these risk adjustment type programs. The times of seeing reimbursement associated with improved diagnosis reporting has arrived!

Although the HIPAA mandated ICD10cm codes are used for reimbursement and tracking payments, one of the main purposes of ICD10CM reporting is to provide vital statistics in epidemiological tracking illness and injury. When we start to understand what the diagnostic data is telling us, it begins to make sense why everyone is paying so much attention to the quality of these codes.

Aside from tracking payments and improving patient care, quality ICD10CM reporting accurately represents the clinics patient population, protects revenue by supporting medical necessity, and helps to reduce risk for third-party audits.

Consider the following Take Homes when it comes to improving the quality of your diagnosis reporting: Let us know what BCA can do to help you!

  1. Appreciate the Impact of Accurate Diagnosis Reporting
  2. Know the Rules: Educate Team on Specificity for conditions treated most often.
    • Review for updates regularly
  3. Update Problem Lists: Build a helpful toolbox, use your Team (or ours!) for support
  4. Recognize EMR Challenges/Inaccurate Descriptions
  5. Provide Coding Support/Outreach/Education/Quick Reference Tools