Maximizing Resources for ICD-10 Coding Audits

by Julia Hammerman, RHIA, CPHQ, and Sam Champagnie 

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.

Copyright Association of Clinical Documentation Improvement Specialists (ACDIS).  Article reprinted with permission.