The following is a guest blog post by Wendy Coplan-Gould, RHIA, Founder and President of HRS Coding.
It’s Thanksgiving weekend—a time for reflection and gratitude. Thoughts typically turn to family, friends, health, and life’s many other blessings. In addition to all of these, this Thanksgiving I suggest that the healthcare industry also include ICD-10 in our list of godsends. Here are five reasons why:
Reason #1: To Code New Diagnosis, Procedures and Devices
The current ICD-9 coding nomenclature was developed in the 1970s. The healthcare industry can’t afford for this same system to be capturing data in the 21st century. We need the ability to specifically code new diseases, procedures and devices. For example, U.S. healthcare providers are unable to precisely code Ebola in ICD-9. That’s true.
There is no specific code for the diagnosis of Ebola in ICD-9, only a general code 078.89, other specific diseases due to viruses. In ICD-10, the code is A98.4, Ebola virus disease. This is the kind of data specificity that our nation needs and ICD-10 delivers.
Reason #2: To Help Keep Patients Safe through Better Data
ICD-10 also helps the healthcare industry capture and track data, and use it to ensure the safety of our patients. The inability to have specific data at our fingertips can be crippling to an institution and result in erroneous decisions based on faulty or imprecise data. Be thankful for ICD-10’s ability to accurately pinpoint diagnoses—and support more precise, exact patient care.
Reason #3: To Reduce Costs
Hospitals are strapped for money. Costs must be reduced whenever and wherever possible. ICD-10 will help hospitals properly bill for the services they deliver. With ICD-10 fully implemented and clinical documentation more granular, hospitals will experience fewer payer denials, claims audits and reimbursement appeals. Valuable time, money and resources will be saved over the long run.
Physician practices also have reason for thanks. New data published on the Journal of AHIMA website earlier this month suggests that the estimated costs, time and resources for offices to convert are “dramatically lower” than original estimates. According to the article, the actual conversion cost for a small practice ranges from $1,900 to $5,900, which is 92 to 94 percent less than initially predicted, resulting in a faster return on investment for your ICD-10 efforts.
Reason #4: To Improve Quality Scores and Performance Rankings
Setting aside zany codes and implementation barriers, ICD-10 is a blessing for quality reporting and performance scorecards. ICD-10’s code granularity works hand in hand with improved clinical documentation across all disciplines to help organizations achieve more accurate quality scores and competitive rankings. This is good news for hospitals and physicians alike.
For example, in ICD-9-CM, there is only one code (427.31) for atrial fibrillation. In ICD-10-CM, physicians must specify the atrial fibrillation as paroxysmal (I48.0), persistent (I48.1) or chronic (I48.2), providing the specificity for a secondary diagnosis that can affect severity of illness scores and impact quality measures.
Reason #5: To Strengthen Hospital-Physician Relationships
ICD-10 is a bull’s-eye for governmental delay. And physician groups are usually the archers behind Congressional action against ICD-10. As recently as this week, physicians were pushing legislators to delay ICD-10 yet again. However, the tide may be turning.
In an effort to help their laggard physicians, many hospitals are reaching out to assist practices and groups in four key areas:
- ICD-10 assessments
- clinical documentation reviews
- technology upgrades
- physician-coder education
Helping physician practices with ICD-10 is an olive branch that must be extended to realize the full potential of ICD-10. Savvy organizations are using ICD-10 as a pathway to better hospital-physician relationships. Finally, AHIMA, MGMA and AMA have offered resources specifically designed to clear up common misconceptions and concerns physicians have about ICD-10.
No More Delays
It is estimated that the last delay cost the healthcare industry approximately $6.8 billion in lost investments, not including the cost associated with missed opportunities for better health data to improve quality of care and patient safety as mentioned above. Everyone from CMS to AHA, AMA, MGMA and HIMSS has endorsed the move to ICD-10 on October 1, 2015.
The rallying cry from hospital executives, IT directors and clinical coders is clear—no more delays! Even payers are pushing for the October 2015 date with a new consortium featuring Blue Cross Blue Shield of Michigan and Humana leading the charge. As Dennis Winkler from Blue Cross Blue Shield of Michigan states, “ICD-10 is good for the industry. . . . It is in everyone’s best interest to work together and ensure readiness across the board.”
Be Thankful
In Mitch Albom’s 2009 New York Times best seller, Have a Little Faith, the author asks an 82-year-old rabbi to identify his secret to happiness. “Be grateful” is what the rabbi repeatedly claims to be the only true route to happiness.
So next time your executives, staff or physicians are complaining about the transition to ICD-10, remember the five reasons described above . . . and be thankful.
About Wendy Coplan-Gould
Wendy Coplan-Gould is the embodiment of HRS. She has led the HIM consulting and outsourcing company since 1979, through up and down economies and every significant regulatory twist and turn of the last three decades. Long-time clients and new clients alike are on a first-name basis with her and benefit from her focus on excellence, reliability and flexibility. She has been published in the Journal of AHIMA and other recognized publications, as well as conducted countless professional association presentations.
Prior to starting HRS, Wendy served as assistant director, then director, of Health Information Management at Baltimore City Hospital. She also was associate director of the Maryland Resource Center, which provided data for Maryland’s Health Services Cost Review Commission, an early adopter of the Diagnosis Related Group (DRG) methodology. Wendy is available via email: wendy@hrscoding.com.
Thank you for posting the positive. Perhaps next THanksgiving, we can be thankful that ICD-10 was finally implemented!
This is great. We must continue to move forward with ICD-10 implementation–there cannot be another delay. We must get the word out that ICD-10 is necessary and not something that can wait any longer. I will be sharing with my legislators.
#NoDelay #ICD10Matters
As an EP
I can tell you that ICD-10 is nothing to be thankful for…
Here are the counter reasons to your reasons:
1. The Code Set for ICD-10 was developed in 1983 and final in 1992. That
is well over 20 years ago. Hardly shiny, new or efficient
2. There is NO evidence that any code set makes ANY patient
safer during decision making by EPs. Most ICD-9 codes used are
nonspecific codes and the same will be for ICD-10
3. Not 1 study says ICD-10 will reduce costs. AHIMA has a big
conflict of interest to say that it won’t be as bad as originally thought.
I can tell you the costs to implement ICD-10 in our practice will be huge.
Not 1900 to 5900. Are they kidding? That article has been WIDELY panned
as self serving of its members that get paid for ICD-10 consulting and implementation.
And not at all realistic.
4. Again, coders and EPs are not going to spend a zillion hours drilling down for
granularity. They don’t do it now for quality or performance when able in ICD-9, why
would they in ICD-10?
5.There is NO evidence that ICD-10 will strengthen hospital physician relationships, furthermore
we have seen no efforts to assist us in ICD10.
So don’t believe the hype.
If CMS or AHIMA want ICD-10, phase it in. No hard date. The chosen reason why they cannot
phase it in, is that the patient will have different codes for the same encounter from different entities.
Well that happens already. I have no idea what codes the hospital uses for hip fracture, even though
we as separate billing private practice ortho, may be more granular, in the few cases I have reviewed, the hospital uses generic fracture codes. So even then different entities use different codes already, so I don’t know what the problem would be anyway if we used ICD-9 or 10 for the same encounter.
If ICD-10 is SOOOO easy, but the costs on CMS to program and phase it in. Not on EPs. And if its SOOOO easy, then let TRUE end-to-end testing happen. Right now, there is NO way an EP can do end to end testing. Right now you have to pick one of 3 weeks in the next year, contact your MAC (good luck there), HOPE you get picked as one of the random drawing of practices to just test your eclaim. OH, and it won’t be true end to end as there is no real payment at the end. And that is ONLY CMS. No other payor is doing any end to end testing. Finally in Ohio, Ohio BWC will NOT be doing ICD-10, so we will have to remember and keep both code sets anyway. How about them apples?
I am sure there will be other payers that will say the same thing.
So I am telling you. Forget ICD-10. Its just another dumb idea to pile on an already full bandwidth of EP over burdening.