As the east coast braces for Hurricane Joaquin, the US healthcare system has just been hit by a tsunami of code changes. Today, doctors, hospitals and health insurers must start using a new diagnosis code set fondly known as – ICD-10. There is much trepidation surrounding the shift and many unknowns, but the change also brings with it many benefits.
What does it mean for providers?
Nobody said change is easy, and that will certainly be the case for ICD-10. Even the ICD-10 Ombudsman, admitted it would be a rocky road. So, what should providers expect? Implementation could trigger a decrease in coder productivity, backlogs in coding and billing, a fluctuation in performance metrics, and resource strain on clinical documentation programs. Revenue may decrease from cash flow interruptions and from increased denials and underpayments. And providers may experience data transmission issues causing a need for re-testing of critical functions and unscheduled vendor updates to ICD-10 software packages. But, it will also help doctor’s provide better care. ICD-10 uses 3-7 alphanumeric digits while 9 uses only 3-5 numeric digits, allowing for five times as many codes. The extra digits enable greater specificity which gives us more sensitivity when refining groups and gives us codes for much finer comparison of mortality and morbidity data. Data that reflects updated medical terminology and classification of diseases. Take for example, a patient with diabetes. ICD-9 classifies type I and II diabetes under the same category, and has insufficient codes to specify the etiologies, manifestations and complications particular to the different cases. With over 29 million Americans living with diabetes, ICD-9’s shortcomings have hindered the development of specialized care plans. By contrast, ICD-10 includes six times the number of codes for accurately communicating about diabetes. In an example of how technology has stretched the ICD-9 capacity, in ICD-9 there is 1 code for angioplasty. That balloons (pun intended) to 854 in ICD-10. The new codes will incorporate the location of the blockage and the device used. With ICD-10, clinicians are able to:
- Specify laterality
- Describe severity of illness
- Specify patient blood type
- Differentiate between initial and follow-up encounters
- Specify the trimester of pregnancy for obstetric complications
- Classify mental health conditions with updated terminology and three times the number of codes
- Measure post-operative complications, contributing to better understanding of patient outcomes
What does it mean for patients?
Most patients have never even heard of ICD-10, yet they will feel its impact. ICD-10 code changes are likely to cause some productivity slowdowns while practices adjust to the new code set, which means patients will wait a bit longer for their doctor’s appointment. It means their EOB statements will be much more detailed and more complicated than before. And there is a real chance that folks with deductibles will see long delays in receiving patient-owed statements. But, it will also improve the quality of medical care. Across the board, ICD-10 improves a doctor’s ability to code with accuracy. This substantially improves communication between primary care physicians, hospitals, emergency rooms and specialists. Using ICD-10 to drill down to the most specific symptoms and diagnoses will better equip care teams to design, implement and assess care plans that are appropriate for individual patients. For example – in ICD-9 there are 9 codes (707 to 707.09) for pressure ulcers. These codes indicate broad location but not depth or stage. With ICD-10 there are 150 codes covering pressure ulcers with much more specificity around location and incorporating the 4 stages of wound severity. ICD-10 provides a better mechanism for describing the care provided to these patients and pinpoints the need for certain services. The practice of medicine has changed and the way we code it has to keep up. The transition to ICD-10, while initially stressful, will ultimately benefit the healthcare industry and allow us to support the ongoing evolution of medicine, to facilitate more sophisticated medical research and to identify and avoid emerging global health threats.
All things must change to something new, to something strange. Henry Wadsworth Longfellow