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How to Perform an Internal Audit for ICD-10 Implementation and Compliance

February 17, 2012 | Comments: 0 | Views: 182

All it takes is these 5 simple steps...

1. Pull a random sampling... this means just 5-10 charts per provider gathering a range of diagnoses for that profession that will cover your most frequently used diagnoses. Many EMR software programs offer the ability to pull lists of visits based on diagnosis or ICD-9 code. You can contact your software vendor if you are unsure how to perform this search.

2. Create a spreadsheet for your findings. This will need to have the following columns (you can add more for your practice needs) Chart or Reference number (this is preferred to using the patients name and date of birth but this can be used as well) date of service, ICD-9 codes, ICD-10 codes, a check box for supported and non-supported and a final column for comments and recommendations.

3. Find a GEMS mapping software or ICD-10 mappings book (both Optum Insite and Contexo Media have both books and online resources) There are several out there that are free however some do require a fee or subscription. Simply search GEMS mapping tool or ICD-10 translator. The ones I have used and recommend are. CMS GEMS tool, Encoder Pro, Code it rite, or AAPC Code Translator

4.Now it's time to start going through your charts... as you go through each one note what the ICD-9 code(s) are for that chart and whether or not they are supported by the documentation. Then use one of the mapping tools listed above or another if you prefer. Note what the ICD-10 code would be and whether or not it is supported by the documentation. What you will find is that the ICD-10 codes require more specificity than ICD-9 codes.

5. Note all of your findings on the spreadsheet you created in step 2. What you will see as you add data to your spreadsheet that your findings are usually really simple things that the provider did do, but wasn't aware that in makes a difference in selecting the correct diagnosis code. Now you are able go to your providers and let them know what is missing with hard evidence and set a goal for improvement with them and a time to perform another audit. I recommend doing at least 3 before ICD-10 implementation depending on the size of your practice and need for Improvement.

That's it! It really is quite simple once you get started. Also if you noticed, you have just created a resource for the future on your most common diagnoses and what the ICD-9 and ICD-10 codes are. Don't get overwhelmed this is something that will save you a lot of time in the future if you just take the time to do it now.

Jody Thompson CPC, CBCS, CMAA. If you have any questions or comments on this article or its content please feel free to contact me.

Source: EzineArticles
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