Updated on: November 21, 2016

ICD-10: Physicians to Payers: Speak Their Language

By Betty Bibbins, MD, CHC, CI-CDI, CPEHR, CPHIT
Original story posted on: May 15, 2015

EDITOR’S NOTE: The following is a transcript from Talk Ten Tuesday’s broadcast on May 12 by Betty Bibbins, MD.

Physician to physician, we must acknowledge that healthcare is changing. ICD-10 is coming on Oct. 1, 2015, and this will add new depths to the language we use to communicate.

As physicians, we are good at communicating physician to physician, clinically speaking, about the practice of medicine. However, when we speak to insurers, who pay for the care that's being provided to beneficiaries, it is important to remember that they have little if any clinical or medical background.

Therefore, we must begin to speak their language in order to not just communicate about the practice of medicine, but to appropriately document the practice of medicine, in terms that third-party payers require and understand. We must keep in mind that even though we've been using ICD-9 since the 1980s, over $4.5 billion was recouped from healthcare providers in 2014 alone! 

We must improve our communication, not just by using more words, but also through more specific diagnostic wording in documenting our practice of medicine. ICD-10 is based upon the foundations of ICD-9. There will be an addition of adjectives to increase specificity so that we will know the exact severity of the illness being managed.

Diseases, as we all know, have a beginning, a greatest point of severity, and then an ending, with three possible outcomes: the patient improves completely, the disease becomes chronic in status, or the patient expires. Therefore, it is very important for us to capture the potential expectations of morbidity and mortality throughout our care management. We also have to communicate about other secondary diseases that may be present, and how they impact the principal diagnosis.

We all have to think critically about these components when treating a patient, whereas in the past we were never required to document them.  Those days are over! We now have to show the medical necessity and our clinical judgment. This is why it is important that physician educators and physician advisors work with attending physicians and residents: to improve the specificity of documentation and to show that patient care is being provided with safety and quality. This will allow insurers to appropriately compensate and profile healthcare providers – both individually as well as for facility providers. ICD-10 is the present and the future of healthcare.

Let us embrace this, because there are no other options. The future is here. We've been talking about this for years, and the rest of the industrialized world has been here since 2008.

This is 21st-century healthcare. 

About the Author

Betty Bibbins, MD, is the founder, CEO, and executive physician educator of DocuComp Healthcare. Dr. Bibbins is also the founder and dean of faculty at DocuEd LLC, the first nationally recognized program that provides clinical documentation specialist (CDS) education and certification for hospitals’ clinical staff, including hospitalists, attending physicians, physician assistants, and nurse practitioners.

Contact the Author

Comment on this Article

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.

Related Stories

  • Things Your Mother Never Told You About HCC: Version 23
    The 2019 CMS risk adjustment model is version 23. The Centers for Medicare & Medicaid Services (CMS) released, in April, the latest update to the CMS-hierarchical condition category (HCC) Risk Adjustment Model (V23).  It applies to payment year 2019.  As…
  • Random Thoughts about ICD-11
    New classification system noted for granularity. Several of my colleagues recently attended an ICD-11 presentation by Kathy Giannangelo[i] at the American Health Information Management Association (AHIMA) Convention & Exhibit. Kathy has been in the trenches with ICD-11’s development for some…
  • Understanding Presumptive Linkage for Code Titles “With” or “In”
    Sharing insights on assumptive coding  When I was a physician advisor, I used to offer a diabetic Charcot joint as an example of why we must be explicit with linkage. Years ago, if a provider listed diabetes mellitus and a…