ICD-10 Gap Analysis and Revenue Projections

The implementation date for ICD-10-CM has been pushed back to Oct. 1, 2014, but it does not mean health care providers have a lot of time. Health care providers that have not assessed, through a Gap Analysis, the impact of ICD-10 should be planning that event…soon. There is a lot to do.

ICD-10 CM is going to impact the entire health care industry.  All health care providers billing for the services they provide will need to transition to ICD-10 coding from ICD-9 coding by Oct. 1, 2014.  The new classification system is drastically different, especially in the specificity of the codes and the sheer number of codes.  Many of the less specific codes will cease to be recognized as impacting resource utilization.  Health care providers will need to improve documentation to improve and take advantage of the specificity provided in ICD-10.  Training for coding specialists, physicians and those who will use the data is extremely important.

An ICD-10 Gap Analysis is performed to:

    • identify areas where additional, more specific, or clarifying documentation is needed to assign the most specific ICD-10 codes possible
    • determine the competence of the coding specialist to interpret clinical documentation into appropriate ICD-10 codes to assure billing compliance using ICD-10 
    • identify how the coding touches each area of work flow
    • determine the financial impact of ICD-10 on reimbursement     


For more information, contact Jennifer Greenhalgh.