It’s too much work. It’s too expensive. It’s too confusing. It’ll slow my coders down. With all the fears, complaints, warnings, and dire predictions surrounding ICD-10, it’s easy to lose sight of the benefits that the new code set will bring to medicine starting on October 1, 2014. Here are a few good things to remind yourself that ICD-10 is a step forward, no matter how difficult the implementation might seem right now.
More codes is a good thing
We all snicker at the idea of there being a code for “struck by a cow” or “walked into a lamp post”, but any emergency department physician knows that turtle bites and chicken coop injuries are barely the tip of the iceberg when it comes to the bizarre cases they see on a daily basis. Would you rather not be able to prove to your patient’s insurance company that yes, they really did fall down the stairs after parading around with a tea cozy on their head?
One of the major benefits of ICD-10 is the ability to tell a more complete, more detailed narrative to justify your treatments. Crochet injuries and duck attacks might not be the norm, but they’re part of a greater push towards specificity and more granular data that will allow physicians to do some surprisingly simple things that are missing in ICD-9, like indicating the location of a fracture.
“In ICD-9, I can’t tell you that I fractured that distal portion of my right index finger,” explains Kathy DeVault, RHIA, CCS, CCS-P, Manager of Professional Practice Resources at AHIMA. “All I can tell in my story to the insurance company is that I fractured a finger. But what if I fracture another finger next week? I’m submitting another claim for a fractured finger, but the insurance company is saying ‘wait a minute; you fractured a finger last week.’ Well, I fractured a new finger, but I can’t show that in ICD-9. We’re just lacking that granularity in ICD-9 that we can get in ICD-10.”
Finding a code will be easier than you think
There’s no denying that 141,000 is a big number. It’s a much bigger number than the 17,000 codes in ICD-9, and that scares a lot of people. But coders don’t – or shouldn’t – code from memory, and physicians are seeing a proliferation of innovative tools to make selecting ICD-10 codes a piece of cake. From real-time clinical decision support to cross-walks to dedicated software to guide physicians to the correct diagnosis code, vendors are coming up with answers to every problem ICD-10 presents.
“I believe the technology should compensate for all of these requirements,” says Kerry Martin of VitalWare. “Physicians will need to be prompted if they don’t say [the right] things.” With Martin’s Sherpa ontology, for example, physicians can input a diagnosis within their EHR and then be asked to drill down in specificity with a couple of clicks until they reach the most appropriate code ICD-10 has to offer, even if it’s “burned by water skis that caught fire”.
Fewer gaps in diagnoses mean better billing
What does this mean for your revenue? Well, it could be a pretty great thing. Experts agree that there will be an initial period of confusion and a significant drop in productivity immediately after the switch as physicians and coders get used to a new way of conducting their business. But when the chaos subsides, practices may see fewer denials from payers for unclassified or insufficient claims.
Physicians will be able to argue for better coverage for seriously ill patients when they’re able to detail the true extent of their condition, which is becoming increasingly vital as payments start to be tied to quality of care rather than quantity of services. Physicians will be able to track improvements with subsequent encounter codes and detail multiple chronic conditions to justify their actions and show how well they are managing the quality of life for their patients, which might mean more money coming into the practice.
Medical research is about to get better
Population health management and medical research rely on structured data that can be manipulated and studied. ICD-10 will provide that on an unprecedented scale with its detail and breadth. There’s almost no diagnosis that can’t be accurately captured in ICD-10, giving researchers a new wealth of data to explore that will include rare diseases and unusual symptoms.
It might not seem like an immediate benefit to an independent physician scrambling to make arrangements for his only administrative staff member to attend a training class, but five years down the line, that physician may see a patient whose life will be saved by the work of academics looking at ICD-10 data.
Everything you’ve been doing has been leading up to this
Opponents of ICD-10 argue that there’s simply too much going on. EHRs, meaningful use, accountable care, Medicare cuts, HIE…the list goes on and on. Small practices are struggling to keep their doors open while pouring thousands of dollars into health IT initiatives, so why add another burden to their shoulders? Because ICD-10 is at the root of it all.
“One of the arguments is that there are too many competing priorities for physician practices and hospitals,” DeVault said. “But a lot of those all come together. A lot of EHR systems and computer assisted coding tools are designed with ICD-10 in mind. The ICD-10 codes help build that meaningful use of data. But you can’t look at these things in silos. ICD-10 really needs to be looked at as a convergence of projects that all work together to improve quality of care. They work in concert with each other, not in competition.”