Despite Headlines, ICD-10 Does Have Its Supporters

We are nearly three months removed from the oft discussed ICD-10 deadline, currently scheduled to take effect Oct. 1, 2015. Barring any last-minute shenanigans by those in Washington, there is little do but wait, and prepare as best as possible for the transition to the new code set in the time remaining.

While there remains plenty of activity on Capitol Hill to, in the very least, delay parts of the roll out of ICD-10, there are countless organizations and individuals who are actively lobbying against a change to the 10th version of the International Classification of Diseases. For example, the American Medical Association has been a staunch antagonist rallying its members against the change. And, as recently as May 2015, the Heritage Foundation, with its report titled, “The New Disease Classification (ICD-10): Doctors and Patients will Pay,” made some strong recommendations against it: “While an updated diagnostic system for disease classification might be in order, there are significant costs and trade-offs,” write Heritage authors John O’Shea, MD, and John Grimsley, reported by Healthcare IT News. “To protect practicing physicians and other healthcare workers from such an unfunded mandate, Congress should delink the disparate goals of research and reimbursement, and develop a more appropriate coding system that makes the billing process less, not more, burdensome.

“In the interim, Congress should allow providers to have the choice of continuing to use the current ICD-9 system or adopt the new ICD-10 system until the alternative reimbursement arrangement is complete.”

However, given this level of dissent toward ICD-10, or the level of dissent that’s reported by the major healthcare news organizations, there’s actually a good deal of support for the change in code sets. When asked about moving ICD-10 forward or further delaying it, the responses received by Electronic Health Reporter were overwhelmingly in favor proceeding with the current timeline, and by no small margin. The following  comments from some of healthcare’s insiders provide proof of that, and show that there are those among us that want to move on as soon as possible, and put the past to rest.

Dr. Jon Elion
Dr. Jon Elion

Dr. Jon Elion, MD, FACC, founder and CEO of ChartWise Medical Systems
I’m in favor of the transition to ICD-10 this October. The ICD-9 code set no longer provides the level of specificity necessary to adequately account for many of the patient ailments physicians are seeing today. After 30 years, the code set is outdated and cannot describe all of the diagnoses and procedures that have been discovered or created during that time. Many codes have been “lumped” together so that meaningful statistics and data analysis are not possible. For example, suturing the aorta (largest artery in the body) has the same ICD-9 code (39.31) as suturing an artery in the hand, despite the fact that they are vastly different in the resources the hospital expends in supporting the different procedures. Furthermore, delaying the transition again will only serve to prolong the limbo hospitals, medical centers and physicians have been in for the past few years. Waiting until ICD-11 also isn’t an option as the first versions won’t be ready until 2017 at the earliest and it will be years after that before a version is prepared that will work for the complexities of coding inpatient morbidity and mortality. ICD-10 is the best option we have right now to provide the level of detail physicians and coders need to properly convey patient symptoms and diagnoses.”

Keith Eggert, FHFMA, executive vice president and general manager, healthcare, VisiQuate

“In the short term, converting to ICD-10 has been a significant undertaking for the industry. But in the long run, it’s a valuable investment because more specific Dx and inpatient procedure codes can lead to more precise diagnostic, utilization and billing data, which positively affects revenue capture. They can also have a positive impact on clinical outcomes. Fortunately, there are third-party vendors who have solutions that eliminate much of the staff time and expense needed to convert to ICD-10 manually.”

Kimberly Vegter CPC, CPC-I, AAPC certified ICD-10 Trainer; coding services for MediRevv

I can honestly say with a resounding yes, I am in support of the ICD-10 transition. At this point, I feel any provider that is not ready for the transition, will never be ready and any further delay will add more burden than relief. I have been teaching ICD-10 since 2011 and I know the providers that I spoke to before the last delay were frustrated with the amount of time and most of all money that was spent only to have it delayed one more year.

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“Flight ICD-10 Has Been Delayed, No Further Information Is Available At This Time”

Jeff Rose
Jeff Rose

Guest post by Jeffrey Rose, M.D., CMIO, TriZetto Corporation.

With a flourish of congressional shenanigans lifted almost word for word from the teleplay of Netflix’s House of Cards, the HHS-mandated 2014 transition to use of the ICD-10 coding classification was brought to a screeching one year “delay.” We are left, once again, with “at least” another year of collecting healthcare information via ICD-9, an awful but omnipresent healthcare coding system. And more concerning, we are left with the impression that diligent and expensive work to comply with rules in a host of other areas, such as meaningful use of electronic health records, could become abruptly irrelevant. The result of the delay is that not only do we have a significant number of long-time objectors to the change to ICD-10, but they are also joined by a surge of rightfully angry and dubious ‘compliers’ who put in time and investment dollars to meet the deadline.  But there are also some additional considerations given the amount of time that has passed as we prepare to make the trip.

Is this trip still worth the aggravation and expense?

The major underlying rationale of moving to ICD-10 remains laudable: to provide greater clarity to our understanding of healthcare practices through the use of better industry standard, diagnosis codes.  With more granular, relevant and precise core codes at the foundation, medical quality and effectiveness studies utilizing these codes for analysis and program development were to have benefitted dramatically.

Given that our desire to advance healthcare value and improve outcomes through accountable care practices (‘fee-for-value’) we must acknowledge our dependence on much better information collection for analysis than is possible from ICD-9[1]. Significant questions remain however, as to whether the move to ICD-10, using codes predominantly still entrenched to support fee-for-service billing processes will get us where we want to go.  While we can hope the enhanced and detailed nature of ICD-10 might yield greater insight into the real value of our activities, this remains a particularly frail hope in light of the way we use the codes as revenue cycle fuel.

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