What the conversion to ICD-10 means for providers and healthcare stakeholders
- How difficult will the transition be?
- How tough will payers be in expecting correct coding?
- As a provider, am I going to miss claims?
- Can someone remind me why we’re doing this anyway?
After years of delay, the deadline for providers to implement ICD-10 codes finally arrived on Oct. 1. By that date, all providers affected by the Health Insurance Portability Accountability Act (HIPAA) were to have begun providing claims with ICD-10 diagnosis codes.
“The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions, diagnoses, and institutional procedures and has not been updated in this country for more than 35 years,” wrote Andrew M. Slavitt, acting administrator for the Centers for Medicare & Medicaid Services, in a letter to Medicare providers in July.
“The current code set, ICD-9, contains outdated, obsolete terms that are inconsistent with current medical practice,” he wrote. “As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for improved patient care and public health surveillance across the country, leading to better identification of illnesses and earlier warning signs of epidemics and pandemics, such as Ebola. Over time, ICD-10 will improve coordination of a patient’s care across providers, advance public health research and emergency response through detection of disease and adverse drug events, support innovative payment models that drive quality of care, and enhance fraud detection efforts.”
Sounds good. Here’s the rub: The new procedure coding system uses seven alpha or numeric digits while the ICD-9-CM coding system used three or four numeric digits. So, whereas ICD-9-CM contained about 4,000 procedure codes, ICD-10-PCS (for inpatient procedures) contains about 87,000.
This expansion of codes doesn’t reflect the emergence of new diseases or injuries so much as more specificity. For example, the new codes accommodate laterality. So, instead of indicating merely “sprained ankle,” providers must specify which ankle was affected. And, whereas ICD-9-CM had one code for angioplasty, ICD-10-PCS has 854 codes, specifying body part, approach and device.
“Epidemiologists ran amok with the coding system,” says coding consultant, author and speaker Betsy Nicoletti, MS, CPC. “Does it really matter which joint the patient has gout in – whether it’s the elbow, shoulder or toe? Does that advance population health? Do we really need to know if a patient has an ear infection in the right ear, left, or both?
Greg Dean, vice president, technology partners, McKesson Medical-Surgical, has a different perspective.
“I believe the conversion from ICD-9 to ICD-10 is a very positive step,” he says. “Although ICD-10 might cause temporary growing pains as the market implements it, in my opinion, the overall outcome is positive. ICD-10 will increase specificity, which in turn provides more detail, and this can help to improve patient care and outcomes. Additionally, ICD-10 could benefit medical research, improve performance, create efficiencies, aid in policy-making, and help in creating new pay-for-performance programs. The increase in detail and specificity can provide more insight for the future of healthcare.”
Even some physician groups voiced support for ICD-10.
“After the initial growing pains, physicians and support staff will be able to communicate easily regarding the specificity of diagnosis and corresponding orders,” says Barbie Hays, ICD-10 certified trainer and coding and compliance strategist, American Academy of Family Physicians. “For example, a classic physician order for a sprained ankle may be an X-ray. If the physician forgets to determine right or left in the order, the technician had to stop the test and query the physician. However, with ICD-10-CM [diagnosis code set for all clinical settings], laterality is built into the code – S93.402A.”
Others are not as convinced.
“Generally, I feel the costs and risks associated with the transition to ICD-10 at this juncture are ill-advised,” says Tom Schwieterman, MD, medical director, Midmark Corp. “The regulatory and compliance complexity already created by Meaningful Use, the [Physician Quality Reporting Initiative, or PQRI], integration of private practices into larger systems, and advancing requirements related to emerging value-based reimbursement has overwhelmed change management initiatives. ICD-10 should be delayed until the dust has settled from previously mandated initiatives.”