Have You Performed A Case Mix Index Check-up Post ICD-10 Go Live?

Organizations did a fantastic job preparing for ICD-10. However, now that the dust has settled, we need to drill down into the data. Specifically, case mix index (CMI). With more than two months’ worth of ICD-10 data, it’s easier to make comparisons and draw logical conclusions. If coding and/or documentation problems exist, they’re likely starting to emerge through your CMI.

Analyzing Case Mix Index Adjustment Data

When analyzing the CMI, take the following steps:

  1. Compare your current Case Mix Index with the CMI during the same period last year. For example, compare the average CMI for November 2014 with November 2015. Is there an increase or dip? Or has it remained relatively stable?
  1. Look at factors that could influence CMI shifts. These include seasonal utilization changes (e.g., changes in patient volume), changes in physician groups (e.g., addition or removal of an orthopedic physician), or service line changes (e.g., addition or removal of service offerings).
  1. Once you rule out these factors, consider coding and documentation trouble spots. If your CMI has decreased, perform focused coding audits to ensure diagnoses and procedures are coded correctly and documented appropriately. This may require additional coder and/or physician education. Solicit help from CDI and physician advisors.
  1. Monitor your volume of unspecified codes as well as the type and frequency of queries. Where do documentation and coding improvement opportunities exist?

The Importance Of Case Mix Index

Your Case Mix Index is a good barometer of your coding and documentation accuracy. What’s your organization’s plan to monitor this going forward? What types of Case Mix Index changes, if any, have you seen post-ICD-10-go-live?

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