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ICD-10-CM/PCS News Archives

Five coding audit best practices under ICD-10

January 14, 2016:

Now that you’re knee-deep in ICD-10, it’s a good time to start thinking about your coding audits. Why? Because identifying coding and documentation issues before you get neck-deep in ICD-10 can help you keep current irregularities from becoming future bad habits.

While coding audits were likely a regular occurrence for your organization before the October 1 conversion, an audit can’t be business as usual in the ICD-10 age. Here are five best practices to help organizations do coding audits right under ICD-10.

Focus your audits on your goals. Goals will vary between facility, specialty and providers. So there should be no such thing as a standard audit. Find out what your high-volume, high-risk diagnoses and procedures are, then focus the audits on finding issues within those areas. Using the old method of random chart selection to simply get a coding quality score for the end of the year won’t do under ICD-10. Use your audits to obtain high quality results that can meet a lot of needs within your organization.

Form an action plan. All too often, audits results are superficially reviewed then filed away. A good audit is actionable, so take action! Look at the data that helped identify the issue, then develop a plan for a targeted re-audit or targeted education. The audit may also point to potential take revenue cycle action, such as rebilling. The goal should be to remediate the problem so that the issue doesn’t come up again in your next audit.

Find an effective frequency. Speaking of the next audit, determine the cadence for your coding audits. We recommend regular audits be not less than once a year, while quarterly audits are our general recommendation. You should decide on your audit frequency based on your unique organizational needs. Consider factors outside of HIM, including revenue cycle and quality reporting, to determine the right frequency for you.

Circulate findings with a detailed report. A report is essential to show the value of the audit dollars you're spending. A report that you plan on circulating outside of the HIM department will need an executive summary, detailed findings, performance broken out by coder, account and specialty, and callouts for DRG shifts and clinical documentation improvement opportunities. Finally, highlight progress or areas needing improvement through graphs that show trending over time.

Take corrective action based on audit findings. Sometimes corrective action is necessary for either coders or managers. When you have reviewed the audit findings, identify root causes for any of the coding issues highlighted, then determine what corrective actions to take. Does the problem need education (due to a lack of knowledge) or training (due to a lack of understanding or bad habits)? If the coder’s productivity falls below a certain standard, how will you remediate? Should you increase your ongoing monitoring activities to be certain to catch issues before they escalate?

Following these best practices will help your organization stay on your productivity and accuracy targets for ICD-10. Perhaps the most important best practice? Start auditing now.


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