The Future of ICD-10-CM/PCS

By Lou Ann Wiedemann, MS, RHIA, CHDA, CDIP, FAHIMA
Original story posted on: January 5, 2015

In a December 2014 statement on the implementation of ICD-10, U.S. House of Representatives Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and House Rules Committee Chairman Pete Sessions (R-Texas) called the new coding set "an important milestone in the future of healthcare technologies." The statement clearly indicated that the congressmen will continue to work closely with the Centers for Medicare & Medicaid Services (CMS) to, as the statement put it, "ensure that the deadline can successfully be met by stakeholders."

Five years after the National Committee on Vital and Health Statistics recommended to the Secretary of Health and Human Services that the regulatory process for ICD-10-CM/PCS adoption be initiated, the healthcare industry is anxiously looking to October 2015 as the point at which the transition could be completed.

The United States healthcare industry is on the verge of a major shift. The introduction of ICD-10-CM/PCS on Oct. 1, 2015 will mark the launch of the most robust, effective, and efficient coding system available. While some groups may look to the coming year as another opportunity to delay implementation, transition is long overdue.

U.S. is Years Behind

Already years behind, the U.S. should have implemented ICD-10-CM/PCS some time ago. Every delay causes U.S. healthcare data to grow more imprecise and incurs significant costs to maintain the old ICD-9-CM code set. Healthcare currently represents a data-rich environment, and contemporary data needs are dramatically different than they were 20 years ago. Being able to pull data from electronic health records is being touted as one of the many benefits of the electronic age. As these systems become more sophisticated, however, the ICD-9 code set remains in the 1970s, failing to adequately represent and report diseases of the 21st century. 

The result is incorrect data, leading to erroneous decisions or conclusions based on faulty or imprecise information. The outdated terminology in ICD-9-CM also regularly results in increased coding errors as coding professionals struggle to identify code assignment for new diseases such as Ebola. The downstream effect of these errors increases administrative inefficiencies associated with tasks such as manual coding processes and record reviews, and lost opportunities to capture costs routinely arise.

The more time passes without ICD-10-CM/PCS being implemented, the more data will continue to suffer. In today’s healthcare arena there is a critical need for high-quality data to support initiatives such as Meaningful Use, quality reporting, and payment reform. 

Adverse Impact of Delays

The healthcare industry simply cannot afford any more delays in ICD-10 implementation. The U.S. Department of Health and Human Services (HHS) has estimated the cost of the last delay at $6.8 billion, and each year of a delay past Oct. 1, 2015 is projected to result in $1 billion to $6.6 billion in additional costs. The costs associated with retraining personnel and reconfiguring systems multiple times in anticipation of implementation is unnecessarily driving up the cost of healthcare. CMS has also concluded that a delay beyond 2015 would have a damaging impact on the healthcare industry as a whole.

All segments of the healthcare industry have invested significant time and resources in financing, training, and implementation of necessary changes to systems, workflow processes, and clinical documentation practices. A further delay would require stakeholders to restart their system preparation and would result in them not being able to leverage past system investments.

Most Stakeholders are Prepared

CMS noted in the final rule changing the ICD-10 compliance date to Oct. 1, 2015 that many stakeholders are prepared for the transition already, having invested significant time and resources towards implementation. Those prepared now are understandably frustrated that their momentum and planning went to waste, and that they were forced to go back to the drawing board to develop an extended timeline. And while the process has been disruptive and costly, the majority of organizations remain on track with end-to-end testing and staff training.

Since the 2014 delay, proponents of ICD-10 still face the challenge of convincing skeptics of ICD-10’s benefit; however, using the extra time to focus on education, clinical documentation improvement, and testing with business partners allowed many to remain positive. Unfortunately, those currently prepared remained concerned that extra time will not necessarily equate to preparedness. 

Stakeholders agree that the transition to ICD-10-CM/PCS remains inevitable and time-sensitive because of the potential public health risk and the need to track, identify, and analyze new clinical services and treatments available for patients. Avoiding further delays in implementation is critical in order to limit costs and leverage better healthcare data. Active engagement and commitment by all stakeholders is essential for a smooth transition. 

Benefits of ICD-10-CM/PCS 

For all of the bad publicity around ICD-10 implementation, there are tangible benefits to all levels of the healthcare industry. This includes hospitals, payers, physicians, and many others. ICD-10 diagnostic and procedure codes, although often maligned, will allow for more granular coding, which will begin to paint a more accurate picture of patient care and outcomes. While initial growing pains are expected with any implementation, once subsided, organizations and providers can expect to see much improvement in workflow processes and data collection. This implementation will be no different.

ICD-10-CM/PCS codes represent the next generation of code sets, which will modernize and expand the capacity of public and private payers to keep pace with changes in practice and healthcare delivery by providing higher-quality clinical information. It will enable improved patient care through better representation of the value of new procedures, improved disease management, and improved ability to study patient outcomes. The code sets also will improve data capture and analytics of public health surveillance and reporting, national quality reporting, health research, and data analysis that will help form health policy decisions. 

ICD-10-CM/PCS have:

  • Greater clinical detail and specificity, which significantly improves the quality of healthcare data used for a variety of purposes
  • Enhanced structural flexibility
  •  Improved ability to capture medical advances; and
  • Updated terminology

ICD-10-CM/PCS will result in:

  • Improved data quality and consistency of coding
  • Leveraged investment in electronic health records (EHRs)
  • Improved efficiencies and lower costs
  • Fewer claims denials
  • Reduced need for supplemental information or manual medical record review for claims adjudication or research
  • Less opportunity for fraud and improved fraud detection capabilities
  • Better overall data

Transitioning to ICD-10-CM/PCS

There are no viable alternatives to ICD-10-CM/PCS, and implementation will take planning, preparation, and time. Those not prepared should begin planning immediately using a host of free resources available. For example:

About the Author

Lou Ann Wiedemann, MS, RHIA, FAHIMA, CDIP, CHDA, CPEHR, is a vice president of HIM Practice Excellence for the American Health Information Management Association. She provides professional expertise and leadership on a range of HIM practice issues.

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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.