WEDI Releases Issue Brief on ICD-10-CM Clinical Indicators

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Educational resource discusses concerns around coding Guideline 19; references further resources

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This issue brief was developed with the intention to provide supplemental information that may be useful as organizations determine how they will handle situations related to the new Guideline Number 19.

WEDI, the nation’s leading authority on the use of health IT to create efficiencies in healthcare information exchange, announced the release of an educational issue brief regarding the 2017 ICD-10-CM Official Guidelines for coding. This issue brief was developed by the WEDI ICD-10 Workgroup and ICD-10 Coding and Translation Sub-Workgroup with the intention to provide supplemental information that may be useful as organizations determine how they will handle situations related to the new Guideline Number 19.

WHAT: Section I (Conventions) of the 2017 ICD-10-CM Official Guidelines for coding and reporting includes a new Guideline Number 19 titled “Code assignment and Clinical Criteria.” This guideline states “The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.”

WHY: This has caused some concern in the industry, mainly due to reporting and auditing of the many quality programs currently in place and being planned for in the future. While this guideline puts in writing what is an age-old process, current regulations, medical necessity requirements and audit programs negate this type of coding.

Download the 2017 ICD-10-CM Clinical Indicators Issue Brief here.

For more information on WEDI’s industry efforts surrounding ICD-10, please visit the WEDI ICD-10 Workgroup page.

About WEDI
The Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation’s healthcare system. WEDI was formed in 1991 by the Secretary of Health and Human Services (HHS) and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit http://www.wedi.org and connect with us on Twitter, Facebook and LinkedIn.

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Jennifer Jennings
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