ICD-10: Fact vs. Fiction

by Terrell Warnberg, Managing Director, Dell Services Healthcare Consulting and Annette Munson, RN, ICD-10 Project Manager, Dell Services Healthcare Consulting

ICD-10 will offer a number of far-reaching benefits. Greater specificity of codes and enhanced clinical documentation will capture healthcare information more effectively. Better information will lead to better patient care and improved measurement of healthcare quality and safety. Better information will also lead to improved operational effectiveness, helping providers reduce the cost of care.

There are a number of widespread misconceptions regarding what the transition from ICD-9 to ICD-10 entails. To help you achieve a timely and successful transition, we’ve addressed some of the most common myths and realities.

Fiction: My system vendor will handle the ICD-10 implementation for me.
Fact: The system vendor’s role is limited to addressing the technology aspects of a particular application; workflow integration with other applications is actually the health system’s responsibility.

Vendors are responsible for ensuring any data fields that currently capture ICD-9 diagnosis codes will be able to accommodate the expanded code set under ICD-10. This does not address the need for enhanced documentation for the increased specificity required under ICD-10. Nor does this address any reporting needs of data flowing from one system to another or to an external reporting agency.

Fiction: The Health Information Management (HIM) department will handle all our ICD-10 implementation needs.
Fact: Some organizations believe the transition to ICD-10 is primarily a coding and IT issue. In reality, ICD-10 will have an enterprise-wide impact starting with scheduling, continuing through to performance-reporting to state and federal regulatory agencies.

Many impacted systems and processes will reside outside of HIM control, such as contract modeling, quality management, infection control and operating room charge entry.

Documentation templates and forms will need to be reviewed and revised in areas with significant changes under ICD-10, e.g., obstetrics. Education for physicians and staff will be critical but will need to focused clinically specific topics.

Fiction: The large number of ICD-10 codes will make it impossible to use.
Fact: Undoubtedly, the ICD-10 code set has grown, both in volume and complexity. ICD-10 has 140,000 codes, compared to 25,000 codes in ICD-9. Additionally, the new system uses three to seven digit, alpha-numeric codes, whereas ICD-9 uses three to five digit, numeric-only codes.

On one hand, the greater specificity and detail of this new code set may initially increase the time coders take to identify the right code for a claim. Industry experts estimate at least a 10 percent decrease in coder productivity, possibly more. International lessons learned from ICD-10 implementation stress education; educate early, often and repeatedly.

The Centers for Medicare and Medicaid Services (CMS) anticipates that the improved structure and granularity of ICD-10-CM will require more sophisticated electronic coding tools to help speed code selection. However, the specificity and clinical accuracy of the ICD-10-CM code set is also likely to make it easier to identify the correct code and help reduce the time spent on deciphering ‘unclear’ or ‘vague’ codes. In addition, having an active, concurrent clinical documentation improvement program will provide real-time support to physicians as well as proactive support for coders.

Fiction: Reimbursements will not be impacted by the ICD-10 transition.
Fact: The transition to ICD-10 is expected to increase the complexity of medical necessity claim edits. It may also increase the volume of Medicare severity diagnosis-related groups (MS-DRGs) due to improved clinical information reporting.

As coders, physicians and payers adjust to a new coding methodology simultaneously, there may also be initial coding-related delays and backlogs, as well as requests for further information. All these factors point to the likelihood that migrating to the ICD-10 code could impact cash flows. It is important for organizations to understand and plan for this impact. Contracts may need to be renegotiated with careful attention paid to payer requirements for preauthorization, clauses related to carve outs and penalties for readmissions or hospital-acquired conditions.

ICD-10 is much more than a coding and technology change. ICD-10 presents organizations with the opportunity to enhance the current healthcare operating model and create the foundation for an evolution in healthcare, but adequate planning and preparation is critical. Begin now to assess key areas of focus, budget for technology enhancements and develop collaborative enterprise-wide implementation plans.

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Posted in: Fiction,ICD10