July 9, 2013

Dispelling More ICD-10 Myths

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What follows is a continuation of some thoughts I shared in a previous article titled “Dispelling Some Myths About ICD-10.” As a reminder, here are my first three myths:

  • Myth No. 1: The increase in documentation required by ICD-10 will involve a huge amount of content added to the medical record.
  • Myth No. 2: All ICD-10-CM codes will be complex, seven-character codes.
  • Myth No. 3: ICD-10 requires knowledge of unnecessary and unknown details of a patient’s illness or condition.

Again, these are common myths that continue to plague all of our efforts to obtain buy-in and motivate our impacted populations to want to learn more about and prepare for the transition. Some of these myths are just nuisances, while others are true showstoppers that undermine the efforts of our industry.

And here are two more:

Myth No. 4:

Physicians who choose their own codes will not have to worry about training, as their electronic medical record (EMR) will accomplish this for them.

Truth:

Although EMRs are starting to do some great things in regard to prompts, problem lists, and other assistive ICD-10 tools, they do not take the place of required education for physicians selecting their own codes. One of the biggest concerns associated with ICD-10 involves driving accurate representation of the severity of patients’ illnesses (and hence, the medical necessity of the procedures and tests we perform). If a secondary condition is not on our problem list or we do not have quick access to more specific code choices, physicians may miss out on opportunities to capture this greater specificity and severity of illness, leading to possible increases in auditor scrutiny. Documentation education is also key, because if we do not have the documentation to support the codes selected, we open ourselves up to significant risk. EMRs are a vital aspect of our transition to ICD-10, but understanding of the core concepts of ICD-10 physician documentation and coding are required to be successful.

Myth No. 5:

ICD-10-CM is a reimbursement system not built for clinicians.

Truth:

With all the debate about ICD-10 currently going on, one of the key aspects of the new coding set that is often forgotten is the creation and development of it. Its origins can be traced back to the World Health Organization (WHO), which through the efforts of a team of physicians, clinicians, coders and other healthcare professionals put the new coding set together (and then it was further modified in the United States by a team of clinicians and other healthcare professionals). The system is far more rooted in current clinical thought and practice than the ICD-9 system, but it has not been able to shed its coding-only, reimbursement-only reputation.

Consider one example of how ICD-10 is more clinically focused, however: hemorrhoids. Today, physicians lack the ability to code in a way that illustrates the true severity of a patient’s hemorrhoids. There are simply very few choices in ICD-9, and most end up being classified as simply “external” or “internal.” No matter how severe the case, we still need to choose from these limited options. In ICD-10-CM, however, hemorrhoid codes are structured clinically (that would be the opposite of the myth). With ICD-10-CM, we will be able to choose the grade or degree of severity, ranging from first-degree to fourth. As we all know, more severe cases of many conditions take longer to diagnose and treat. Likewise, in ICD-9, we have no way to show why we purchase as many goods and services as we do, but ICD-10-CM offers that opportunity. Interestingly, ICD-10 does not just offer more code choices (in fact, there are fewer ICD-10 codes for hemorrhoids than in ICD-9), but instead it presents better and more clinically relevant codes.

This is only one example, but it’s a point we must communicate to others in order to ensure that the clinical nature of the system is understood.

About the Author

Thomas Ormondroyd, BS, MBA, is vice president and general manager of Precyse Learning Solutions. He oversees several business lines, including www.precyseuniversity.com, ICD-10 Consulting and Education, and Clinical Documentation Improvement Services. Tom and his team also are responsible for building Precyse University, a revolutionary online learning system and program launched to deliver education to prepare healthcare professionals for the challenges of today and tomorrow.

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