March 09, 2018
From internal reviews to external inpatient coding audits, healthcare organizations nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind. MS-DRG validation audits under ICD-10 have also become more strategic to realize a hospital's revenue cycle success. Coding audit best practices shifted following the implementation of ICD-10. Since all coding stakeholders were comfortable with ICD-9 and needed to maximize budgets, audits were primarily focused on targeted DRGs versus overall coding compliance reviews.
With ICD-10, more frequent audits can help identify the root causes of coding errors before they become ingrained as bad habits. More frequent audits can deliver a positive return on investment, based on assessing coder competency, measuring code quality, and showing how missed errors can have negative effects on an organization’s bottom line. Under ICD-10, coding audits have proven cost savings.
The most common areas for ICD-10 coding errors identified through coding audits include:
Not coding to the greatest degree of specificity
Missing combination diagnosis codes and linked diagnoses
Inaccurately assigning codes for complex cardiac surgeries
Misinterpretation of coding guidelines
Misidentifying appropriate root operations
Incorrect assignment for spinal surgeries
Based on these common errors, a combination of random and focused coding audits has become industry best practice.
Editor's note: Hammerman, director of compliance and education, has more 30 years of leadership experience most recently as the enterprise HIM operations manager for BJC Healthcare. Champagnie, senior director of HIM operations at HIMagine, has 23 years of healthcare business management experience. Opinions expressed are those of the authors and do not represent HCPro or ACDIS. This article originally appeared in HIM Briefings.
The Ohio Health Information Management Association (OHIMA) is Ohio's professional health care organization of 4000 credentialed specialists in the field of health information management (HIM). OHIMA is a non-profit, component state association affiliated with the American Health Information Management Association (AHIMA) and their 103,000 credentialed health information management professionals nationwide.