January 8, 2013

Dispelling Some Myths About ICD-10

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The ability of any organization to transition to ICD-10 successfully will be dictated by both the specificity and adequacy of documentation – and whether that documentation will be detailed enough for coders to code accurately under ICD-10.

This will require a tremendous amount of training and education, not just for coders and clinical populations, but for every population within a healthcare organization that is part of the revenue cycle. But before planning the necessary training and education, we first must dispel some of the negative myths regarding the process.

Such myths can create a hopeless view of the ICD-10 transition and discourage utilization of training and education programs. If we expect colleagues to take the time out of their busy schedules to participate in these programs, then we need to clear the air and show them how the process will be a benefit to both them and the organization in which they practice or are employed.

Myth No. 1: The increase in documentation required by ICD-10 will demand a huge amount of content added to the medical record.

Reality: In most cases, ICD-10 will require just a few more words per documented condition.

The good news is that physicians already should know all this information as part of the clinical story gleaned from their encounters with patients (or the encounters reported to them by ancillary departments).

All physicians need to do is make sure they actually document this information. And physicians may be aware of the new terminology required already due to changes in clinical practice. A good example of this is asthma: Physicians already should be using clinical criteria to establish stage of asthma, as ICD-10 now allows documenting and coding of these stages.

Myth No. 2: All codes in ICD-10-CM will be complex, seven-character codes.

Reality: There are three character codes in ICD-10-CM, and the most common code length is four characters. Therefore, in many cases the ICD-10-CM code will actually be shorter than its ICD-9-CM counterpart.

Moreover, ICD-10-CM is a more logical system than ICD-9, because the first character of the code indicates the category of disease. This way, even a non-coder can look at a code and immediately tell under which disease family the code falls. In many cases it would take multiple ICD-9 codes to tell the same clinical story as just one ICD-10 code. The result is the increased detail level of ICD-10 reduces the chance of error and provides improved assurance that facilities will be reimbursed appropriately.

Myth No. 3: ICD-10 requires knowledge of unnecessary and unknown details of a patient’s illness or condition.

Reality: We all have read the amusing articles and stories about ICD-10 codes noting what a person was doing when he or she were injured. The infamous jet skis catching on fire has been a favorite one. However, while it is important that all impacted populations become familiar with ICD-10, it is not required that everyone know every code and dig up all unknown details of every encounter. Federal officials have compared ICD-10 to a phone book. Denise M. Buenning, MsM, acting deputy director of the Office of E-health Standards & Services (OESS) stated, “All the numbers are in there. Are you going to call all of the numbers? No. But the numbers you need are in there.”

Remember that ICD-10-CM/PCS will be used not only in all regions of the United States, but also at every military base, domestic and international, and even by NASA (that V95.41XD code of Spacecraft crash injuring occupant, subsequent encounter, makes a little more sense, considering). Is it a little over the top? Perhaps, but the key thing to remember is that if a patient’s jet skis did catch on fire, or if he or she was bitten by a parrot, you pretty much can bet this will be noted in the medical record.

Again, ICD-10 education is not meant to teach physicians or other clinicians how to find out a patient’s innermost secrets, but rather to teach them how to document what they are told in their normal discovery efforts – and to teach the coder how to find the code when it is documented.

About the Author

Thomas Ormondroyd, BS, MBA, is vice president and general manager of Precyse Learning Solutions. He oversees several business lines, including Precyse University, ICD-10 Consulting and Education, and Clinical Documentation Improvement Services. Tom and his team are responsible for building Precyse University.

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