Battle of the AHIMA Buzzwords: Upcoding vs. ICD-10

I’m heading to Chicago this weekend for the annual AHIMA show. It will be my second time attending, and last year’s experience will be hard to beat. I stayed at the Grand America hotel, which has now spoiled me for days when it comes to tradeshow accommodations (or vacation accommodations, for that matter). The show was in beautiful Salt Lake City, which literally was a breath of fresh air every time I walked from the hotel to the convention center. The show floor was bustling, attendees were friendly and chatty, and exhibitors were eager to talk about their latest offerings in the world of coding, transcription and health information management, with a dash of healthcare IT thrown in for good measure. And how can I forget the great networking off the show floor? Those HealthPort folks sure know how to karaoke!

Needless to say, AHIMA set the bar high in Utah, and I’m eager to see if my experience in Chicago will live up to it. The time definitely seems right for talking to providers and vendors about ICD-10, of course; but I believe ICD-10 has met its match in the EMR-related buzzword “upcoding.” You may have seen it mentioned in the major news outlets in recent days, read John’s post about EHR Incentive Increasing Medicare Costs, or come across this statement from the government:

“There are … reports that some hospitals may be using electronic health records to facilitate “upcoding” of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care.

“False documentation of care is not just bad patient care; it’s illegal.”

The government obviously means to let providers know that inappropriate documentation will result in legal action, but there is another side to this story in that some providers claim they aren’t “upcoding,” but rather more accurately documenting care now that they have the technology to do so. For hospitals that are struggling financially, implementing new EMR/billing technology may simply allow them to clean up their documentation and billing methods. Seems to me that it’s pretty easy to immediately go from red to black if you’re used to using paper, but now have all kinds of efficient technology at your fingertips.

At any rate, the upcoding conundrum has, for me, elucidated the link between coding and documentation, the EMR and a healthcare facility’s fiscal health. Harold Gibson makes a number of good points around this relationship is his recent blog, “Medical Documentation Specialists can do Better Medical Billing:”

“The medical record is the basis for every financial transaction that follows its creation. EHRs have the advantage of being instantly accessible to a credentialed medical coder or biller at any location. The value of EHRs cannot be underestimated, nor can computer assisted coding software, but they are not a panacea for the elimination of billing errors.”

I hope to find out as I walk the show floor next week how vendors and providers alike are trying to get past this problem. If you have any insight, please share them in the comments below, or, if you’ll be at the show, grab me on the show floor for a quick chat.

Also, if you’re in Chicago and/or at AHIMA 2012, then be sure to come by the AHIMA Tweetup on Monday, 10/1 5:30-6:30. Swissotel, Friedman Marketing suite.

About the author

Jennifer Dennard

Jennifer Dennard

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.


  • Buzzwords are cool…but just words. I’d think people should be more interested in Buzz Phrases or Buzz Equations.

    Like “(CDI + CAC + EHR) = Most accurate, highest value ICD-10.

    Clinical value or not, it all still boils down to legally and ethically maximizing reimbursement.

    Then there’s “CDI + ICD10 = Best HCC” which is another equation altogether.


  • “legally and ethically maximizing reimbursement” – well put Steve. I’ll be interested to hear what providers on the show floor have to say about this “upcoding” business, and what their reaction was to the Sebelius/Holder letter. The few that I’ve talked to thus far are confident that it isn’t a matter of unethical upcoding, but rather more accurate coding that wasn’t as easily done before EMRs and the like. Plus, I get the impression that docs don’t appreciate letters from the government with threatening overtones.

  • Funny that Sebelius is sending threatening letters. Sisko, correct me if I’m wrong, but I seem to remember Medicare saying that it was absolutely ethical to maximize reimbursement so long as it was properly documented. Maybe they said that under a previous administration. With CMS taking back hundreds of millions of dollars with their RAC initiative, what did they expect providers to do?

  • Don,
    Good point. Although, the interesting part is the number of RAC audits that have come back without any issue.

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