Specificity drives coding and reimbursement ramifications: Three changes to understand this year

Why This Topic Matters

The article explains why increased specificity in documentation and code selection can influence claim acceptance, risk adjustment, and revenue cycle operations. It is useful for organizations trying to align clinical documentation, coding, and billing practices with current ICD-10-CM expectations.

Article Sections

1. FY 2018 ICD-10-CM changes and the role of specificity

   Introduces the year’s ICD-10-CM update cycle and frames specificity as a central theme affecting documentation and reimbursement. Provides context for why certain changes may have broader operational impact.

2. Automatic linkage of coexisting conditions

   Discusses changes related to diagnosis linkage concepts and how related conditions are identified in documentation. Also notes limitations that continue to apply under official guidance.

3. Myocardial infarction

   Covers new myocardial infarction coding options and the documentation themes associated with more granular reporting. Includes discussion of related clinical indicators, supporting records, and reimbursement implications.

4. Substance abuse in remission

   Reviews updates that add more specificity for substance-related conditions in remission and places them in a broader reimbursement context. Also addresses the importance of reviewing current treatment and documentation.

5. Revenue cycle collaboration is key to proper reimbursement

   Explains why coding, HIM, CDI, clinicians, and revenue cycle staff must coordinate to support compliant claims. Summarizes organizational practices discussed in the article for managing coding changes and denials.