Article | November 21, 2016

Four Reasons Healthcare Organizations Need To Simplify The Documentation Of The Clinician Diagnosis Process

Source: Health Language
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By Dr. Brian Levy, MD, Vice President and Chief Medical Officer with Health Language, part of Wolters Kluwer Health

Finding and selecting the right diagnosis code is critical to both patient care and revenue cycle management. The downstream negative impact of using an unspecified code can touch everything from decision support to reimbursement, compliance, and reporting. In addition, unspecified codes are not as useful for other clinicians needing to review the records and for patients themselves as they review their own records.

Consider the following four reasons why healthcare organizations need to streamline the clinician diagnosis process to improve workflows, accuracy, and the bottom line:

  1. The number of clinical codes is increasing

The increase in the number and specificity of ICD-10 codes delivers many opportunities for patient care, along with many challenges to workflow. For example, ICD-10-PCS includes more than 75,000 codes after the October 2016 update and

ICD-10 CM includes about 68,000 codes. With the growing number of various diagnoses, clinicians need a quick and easy way to search through thousands of codes to find the appropriate, billable one. Also, with the frequent amount of updates to diagnosis codes throughout the year, healthcare organizations need to have a system in place to manage all these updates to have the most accurate, up-to-date code sets.