July 28, 2014

Discerning Truth Behind ICD-10 Headlines

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Not everything you read about ICD-10 is true. I know, it’s shocking. Sarcasm aside, I feel it is an important point to make since there is a lot of information floating out there about ICD-10 and it takes a level of discernment to ascertain what is the truth and what may just be someone’s idea of the truth.

Case in point: I read the following headline:

“Move to ICD-10 will hurt low-margin practices, study finds” – Modern Healthcare, June 2, 2014

The article refers to a study that was done by the University of Illinois at Chicago and published in the journal of American Academy of Pediatrics. I had actually read the study a couple of months prior to the publication of this article and found it to be a good example of the financial impacts that can arise when there is a reliance on translation tools. I’ve covered the topic of translation in a previous article and feel with articles like the Modern Healthcare one cited above, it may be a good time to revisit translation to quell any anxiety that may come from it—or provide an antidote to any justification for not implementing ICD-10.

First and foremost, a headline such as the one above is meant to be an attention grabber. I get it. They want readers to come to their site and headlines work to pique interest and pull us in. But when we have an industry tied up in knots and bureaucrats looking for ways to stymie progress on what should be a simple upgrade in our health information systems to 21st-century standards, words can be powerful in ratcheting up the angst. So I implore everyone to step back from the onslaught of information about ICD-10, breathe deeply, and clear your mind of any judgments or preconceived notions.

Take the headlines for what they are and do due diligence by digesting the content and researching further. Click the links to the actual studies or source materials. It is time for us to make our own determinations and stop regurgitating talking points.

Second, as I mentioned, the study looked at the effects of translation using the General Equivalence Mappings (GEMs) for a subset of 2,708 codes specific to pediatric practices. And, rightly, the study concluded there were significant discrepancies when the ICD-9 codes were translated to their ICD-10 counterparts. This is not new news. But, since we now have evidence of the effects of translation on a specific specialty area, we can use this information to make decisions about implementing ICD-10. Primarily, how will translations be used in our strategies? Or will they be used at all? After we determine if and how translations will be used in our own implementations, we can ask how our business partners will be using them.

Providers should be coding natively—end of story. There should be no translations that occur at the point of care. If EMR/EHR vendors have provided translation capabilities within their systems, what is the reason? What are the circumstances in which translations should be used? Translations should not be a replacement for coding a service or procedure. In other words, if a provider is thinking they will use the GEMs or some other GEMs-based translation tool in place of natively identifying the appropriate ICD-10 codes, then that is not a financially sound decision to make. Instead, focus on understanding ICD-10 as it is.

Providers who learn ICD-10 find it makes more sense than ICD-9 and is actually easier to use.

Since our healthcare system is a complex web of relationships, providers are only the starting point in the health information process. Mainly, providers rely on health plans to pay for the services or procedures they provide to patients. The majority of health plans have been working on ICD-10 since at least 2008.

Much time and consideration has been given to identify and implement the best possible strategy for ICD-10. Most health plans came to the realization that translation is not feasible and will likely result in financial impacts as was the case identified in the pediatrics study. However, there may be some payers lagging in their efforts or with system constraints that have made it prohibitive to move to natively processing ICD-10 and who instead are implementing a temporary translation solution. If these health plans actually exist, I don’t know. This is why it is crucial to communicate with our business partners.

Providers, vendors, and health plans need to come together now. Beyond testing, conversations need to happen around the strategies that will be in play on October 1, 2015. If pediatric and other providers have the most accurate information about the possible or probable financial impacts to their practices, they can plan ahead and work with their business partners to mitigate the impacts so they are short-lived instead of managing the negative impacts over the long haul.

In the end, after all is said and done, the increased clinical detail and restructuring of ICD-10 make it simpler and more straight forward to use. Translation may inadvertently convolute our processes and cause long-term issues that will require more resources to unwind after implementation. So don’t assume translation is the law of the land. Discern the truth and communicate it.

And for goodness sake, don’t forget to breathe.

About the Author

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial and public payers. She is also co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Coding and Translation Subworkgroup. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Mandy Willis, CCS, CPEHR

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial and public payers. She is also co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Coding and Translation Subworkgroup. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

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