Crack the Code to Payment Accuracy: Why ICD-10 Coding Proficiency Matters Now More Than Ever

Crack the Code to Payment Accuracy: Why ICD-10 Coding Proficiency Matters Now More Than Ever

In today’s reimbursement-driven healthcare environment, one thing is clear: accurate coding isn’t optional—it’s essential. For Skilled Nursing Facilities, ICD-10 coding plays a pivotal role in reimbursement, regulatory compliance, care planning, and risk adjustment. Yet despite its importance, many facilities continue to struggle with coding inaccuracies that cost real dollars and compromise the integrity of resident care documentation.

So what’s standing in the way of payment accuracy? Often, it’s a knowledge gap—one that spans clinical documentation, diagnosis specificity, and MDS alignment. Let’s break it down.

The High Stakes of ICD-10 Coding in PDPM

Since the implementation of the Patient Driven Payment Model (PDPM), coding has taken center stage in determining Medicare Part A reimbursement. Section I of the MDS—and the ICD-10 codes it includes—drives the resident’s clinical category, which ultimately impacts the facility’s case mix and payment rate. If the coding is incomplete, incorrect, or lacks specificity, the reimbursement rate may fall short of the care actually being delivered.

Incorrect coding can also trigger compliance concerns, audits, and denials. From missed capture of active diagnoses to improperly sequenced codes, even small missteps can have major financial consequences.

It’s Not Just a Coder’s Job

While billing and HIM teams typically lead the charge on ICD-10, coding accuracy is a team effort. Physicians, therapy, MDS nurses, and nursing staff all play a role in diagnosis documentation and clinical specificity. A breakdown in interdisciplinary communication can mean lost revenue and inconsistent resident records. For this reason, education and process alignment are critical. Facilities that succeed in ICD-10 accuracy have made it a shared priority across departments—not just something that happens in a billing silo.

Clinical Documentation For Coding Support Case Example

One of the most common pain points? Clinical documentation that doesn’t support—or isn’t specific enough for—accurate ICD-10 assignment. Coders can only work with what’s documented. That’s why provider engagement and diagnosis clarification are key.

Here’s an example: a resident with pneumonia may be documented simply as “pneumonia,” when in fact it’s aspiration pneumonia related to dysphagia. That one missing detail affects not only reimbursement but care planning, outcomes tracking, and survey preparedness.

Sharpening Your Coding Game

Improving ICD-10 proficiency improves compliance and legitimate reimbursement potential. Consider these action steps:

• • Ongoing training for both coders and clinical team members
  • Strong internal processes for diagnosis clarification
  • Tools and resources that promote accuracy and efficiency
  • Audit routines to identify and correct trends early

Ready to Crack the Code?

Join us on April 17th for a virtual ICD.10-CM Coding Refresher workshop where we’ll help you crack the code to payment accuracy through improved ICD-10 coding proficiency. Whether you’re a seasoned coder or a clinical team member who contributes to diagnosis documentation, this session will deliver practical strategies to sharpen your skills and boost compliance. In this workshop, you’ll learn how to:

• • Align diagnoses with MDS Section I and the PDPM clinical categories
  • Avoid common coding pitfalls that lead to denials or underpayment
  • Improve interdisciplinary collaboration to support accurate code assignment
  • Use tools and resources to enhance coding accuracy and efficiency

Don’t leave reimbursement to chance—make sure your coding tells the whole story. Register now here.