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April 3, 2012

Milk and Honey? Nah…

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Almost anyone who writes about ICD-10 shares the same problem each time they take “keyboard to screen” (no longer “pen to paper,” you see), and that is:

What can I possibly write that hasn’t already been written?

This problem is aggravated by the fact that, honestly, ICD-10 is really quite boring.

So, we typically write or talk about:

  • Costs of conversion
  • Crosswalks
  • Education of staff
  • Why ICD-10 is better
  • How to bring physicians on board
  • Who must comply (and who need not)
  • How many more codes there are
  • How late the U.S. is compared to other industrialized countries
  • And so on, and so forth, ad infinitum

As I was creating this list, it occurred to me that perhaps I should take all the usual topics and ignore them. And so it shall be.

History

We all know when the World Health Organization published ICD-10, because that’s another one of the “usual topics.” But let’s consider the following multi-choice question:

When did ICD-10 start to be used in the United States?

  1. Jan. 1, 2012.
  2. Umm…it hasn’t happened yet.
  3. 1999.

If you answered “a” or “b,” you’re wrong. The question was not “When will HIPAA-covered entities start using ICD-10-CM and ICD-10-PCS?” ICD-10 (with no additional letters) started to be used for coding and classifying mortality data on death certificates in 1999. (There are no more questions in the quiz, so you either earned a zero or 100 percent).

Physician Education

Last year I wrote an article titled “What’s Up (With the) Docs?” in which I described several approaches to securing physician support of a hospital’s ICD-10 implementation. As one would expect, it was a collection of practical arguments that could be presented one on one or via a group presentation. However, what it didn’t address was a key issue: simply put, a tiny minority of doctors are just jerks, and a few are nice people but aren’t quite open-minded enough to follow even a simple argument supporting something they dislike.

“Don’t confuse me with the facts,” they say. “My mind’s made up!”

So I have an addendum to that article, which is this:

When you hit a brick wall, go around it or over it – but don’t try to go through it. Don’t let the one out of 100 control your life or compromise your success. They will get their karma in time.

 


 

What Comes Between?

Here’s something I found interesting, and if you are not a coder or a comparable HIM professional, it might be news to you as well:

  1. ICD-10-CM and ICD-10-PCS (along with CPT/HCPCS) will be used to code the care patients receive.
  2. ICD-10 (the WHO version) already is being used to code and classify causes of death.

But what happens in between? Is there any coding system for that period of minutes to years between a patient’s final hospitalization and their “ultimate exit”? Actually, there is.

(Drumroll).

Let me introduce ICF, the International Classification of Functioning, Disability and Health. It is managed by the WHO Collaborating Center for the Family of International Classifications for North America (WCCFICNA?) and is used to code and classify the consequences of disease. How cool is that?

Of course, just because a coding system exists doesn’t necessarily mean anyone uses it, but wouldn’t it be interesting if they did? Imagine that a patient is admitted, cared for by several physicians, subsequently discharged with a relatively clean bill of health, and then tracked (via physician office visits, hospital follow-up and so forth) to see how they are progressing and managing the activities of daily life.

With CMS’s focus on avoidable readmissions beginning on Oct. 1, 2012, this might be a very good way for hospitals to manage patients after they no longer are patients. It’s something hospitals must do if they are to prosper under the new Readmissions Reduction program ordered by Section 3025 of the Patient Protection and Affordable Care Act (PPACA) of 2010.

The Solution for All Our Problems?

Proponents of ICD-10 – myself included – take great joy in noting that ICD-10-CM and PCS address all the shortcomings of ICD-9: there are many more codes, much more flexibility and a more logical overall coding system. But we also usually include an argument as to why this is so good, when, in reality, it’s only good for certain segments of the population and the industry. For everyone else, it may be innocuous or neutral, but it’s neither good nor bad; it’s just there. Let’s face the facts:

As a patient, I very likely will see no benefit from ICD-10. After all, most coding is done after I’m discharged.

As a physician, I expect to see little benefit from ICD-10, unless I happen to be doing research or am really dedicated to the practice of high-quality defensive medicine. But most of what I see is that this new system is expensive and is likely to make me poorer, not richer.

As a hospital executive, I recognize that ICD-10 brings higher costs to HIM, including some employee turnover. And it also provides a multitude of new loopholes that payers can use to deny my claims, in whole or in part. I mean, really: is there any true value in going from one code for a broken finger (ICD-9) to 276 codes (ICD-10)? Doesn’t that just raise the potential for 276 questions?

Yes, the great irony of ICD-10-CM and PCS is that it will help researchers, governments and other payers almost beyond measure … although none of those parties provide patient care.

The End

No, it’s not the end of ICD-10-CM/PCS; we’ve only begun.

And yes, I still support the conversion, but let’s stop pretending that it’s a good thing for everyone. It simply isn’t.

But … is anything the government does good for everyone?

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Read 44 times Updated on September 23, 2013
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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