“It is almost
intrinsic that there
will be a payment
impact to your
RN, MPM, CPC-H, business
development manager at
Wolters Kluwer Law & Business
Conducting a detailed risk assessment is the first step to determining the
“If you can convert your issues into dollar signs, you will get a hospital administration’s attention,” Rossiter said.
A payment impact analysis can be done by translating two or more years of
ICD- 9 hospital claims into ICD- 10, then using the expected Medicare MS-DRG ICD-
10 payment rates to compare reimbursement between ICD- 9 and ICD- 10. While
translated historical data is not the same as live coded ICD- 10 data, the comparison
can enable a close look at reimbursement rates.
The impact can be broken down by facility, DRG, service line, and other line
In an example model, Rossiter showed how some DRGs can lose more than
others. The DRG for “cardiac defibrillator implant w/o cardiac cath w/o MCC”
showed a loss in reimbursement of $663,821 between ICD- 9 and ICD- 10 over the
entire span of reviewed records. However, a look at all Medicare fee-for-service
payments showed a 2. 7 percent increase in reimbursement under ICD- 10.
The model not only attaches a dollar amount to the impact of ICD- 10, but informs strategic planning by service line. ¢
Chris Dimick ( email@example.com) is staff writer at the Journal of AHIMA.
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