AppRev - ICD-10 Analytics for Hospitals and Medical Industry

ICD10 brochure

ICD-10 Analytics

The impact of ICD-10 on each hospital is as unique as the patients and services of those hospitals.

The Issue

The impending conversion to ICD-10 will place hospitals at some degree of financial risk. The financial risk of conversion is difficult to measure, as hospitals do not have the data to model prospective payments under the new coding system. AppRev specializes in predictive analytical solutions for hospitals.

Our Solution

AppRev will perform an analysis of the current MS-DRG/case distribution based on the ICD-9 coding system. AppRev will project the future state of MS-DRG/case distribution based on the ICD-10. The results of this analysis will allow hospitals to understand the financial impact of such a transition. In addition, the analysis will help clients to identify areas of potential improvement in coding and physician documentation that may require greater concern or offer better opportunity under the ICD-10 system. Using a sampling of discharges and codes, we will analyze 100% of the hospital discharges for a given period. As hospitals do not know how the DRGs will change, looking at the “top 25” or other similar approaches may be inadequate or potentially misleading.

Our deliverable will:

Create a list of one to one ICD-9 to ICD-10 MS-DRG assignment
- These may be one ICD-9 to multiple ICD-10 codes but still group to the same MS-DRG, regardless of the ICD-10 selected.
- These may also be one ICD-9 to multiple ICD-10 codes, but will all group to the same new MS-DRG, regardless of the ICD-10 selected.
Identify the instances where a current ICD-9 code transitions to multiple ICD-10 codes AND multiple MS-DRG assignment is possible based on the specificity of the documentation and the ICD-10 codes.
- In these instances, further analysis may be required to identify the critical elements of the ICD-10 selection and the current documentation needed to support the accurate selection of such codes.
- These may be instances where coder education and/or physician documentation education will result in different MS-DRG assignment under ICD-10.
Identify the instances where the Coding Guidelines for ICD-10 varies from ICD-9 guidelines for potential changes to MS-DRG assignment and distributions.

AppRev will use a combination of a proprietary cross walk and re-coding of the cases to create a solution for the hospital for cases indicating MS-DRG assignment.

The following is an example from MDC 4 for respiratory diseases. The presentation is a patient with pneumonia with a secondary diagnosis of an acute myocardial infarction. The procedure is ablation of lung lesion or tissue.
ICD-9 MS-DRG	PDX	SDX	PPX	ICD-10 MS-DRG	Change
163	486	410.91	32.27	163	No
163	486	410.91	32.25	166	Yes
163	486	410.91	32.26	163	No
163	486	410.91	32.27	MDC 4 medical DRG	Yes

Based on above, we would know that all ICD-9 procedure code 32.27 would stay in the same MS-DRG within MDC 4, all ICD-9 procedure code 32.25 would change MS-DRG within MDC 4, and ICD-9 procedure code 32.26 would require review to determine final DRG. ICD-9 procedure code 32.26 maps to 18 different ICD-10 procedure codes. Educational opportunities would exist for physicians and coders for 32.26 equivalents under ICD-10.

Summary

By assessing the financial impact of ICD-10 on the revenue cycle, ICD-10 Analytics will help hospitals best prepare for and optimize the results of their ICD-10 conversion process.