Capture that DX! For More Appropriate Reimbursement: ICD-10 Documentation Made Simple

Marian J. Wymore, MD, CPC, CRC

Marian J. Wymore, MD, CPC, CRC

Time And Place: 9:15-10 a.m. Wednesday, Room 206A; and 12:30-1:30 p.m. Wednesday, Room 217AB

About The Presenter: Marian J. Wymore, MD, CPC, CRC, is a longtime family physician and provider documentation improvement consultant with ICD-10 and risk Marian J. Wy MD, CPC, CR adjustment coding certifications. She realized she could help translate what she knew about coding into more clinically relevant and doctor-friendly terms. She teaches physician documentation improvement to audiences nationally, including provider groups, coders, health plans, and medical group leaders.

"Many providers aren't aware of how specific and complete their documentation must be to generate accurate ICD-10 codes," she said. "I believe that doctor-to-provider education, from a clinical perspective, helps simplify what may seem like complicated documentation requirements into medical verbiage that makes sense, and results in increased reimbursement for sicker patients."

Session Overview: Specific documentation is necessary for accurate ICD-10 code assignments. In risk-adjusted plans such as Medicare Advantage, the difference in payment may be staggering if the provider knows how to document a few key medical terms that more accurately reflect their patient's conditions, and the codes assigned to Hierarchical Condition Categories (HCCs). Wymore will discuss how to expand thought processes during a patient evaluation to include more specific documentation verbiage. Her goal is to make ICD-10 doctor- friendly by teaching physicians how they can use their clinical vocabulary to get the most out of ICD-10. She will also introduce how documentation is relevant to risk-adjusted payments as well as quality measures, and include examples of some of the most common documentation errors.

"When I first looked at ICD-10, I didn't want to learn it either," she said. "But I realized I would have made more money and made the specific diagnosis more often if ICD-10 existed earlier in my career."

Why This Session Matters To you? Accurate ICD-10 codes are necessary for assignment of HCCs, payment under risk-adjusted and fee-for-service plans, data, and quality. "Many payers are moving into value-based payment—taking outcomes, quality, severity of illness, risk, and patient satisfaction into consideration to determine payment," Wymore said. "Physicians need to be aware of the documentation requirements to reflect some of these assessments."

The Take Home: Coding requires specifying the diagnosis to the highest number of characters (3 to 7). Knowing the kinds of key words that most specifically reflect a patient's condition can lead to more-accurate coding, higher reimbursements, less queries, and better quality, Wymore said. Attendees will be introduced to how to document more specifically, clarify acuity versus chronicity (or PMH), establish cause-and-effect relationships for combination codes, support diagnoses, and include quality measures when appropriate.

Of Note: Wymore will lead an Ask the Expert session on this topic at 10:30 a.m. Wednesday in Room 221D.