August 6, 2013

Why Physicians Should Care About ICD-10

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Some healthcare providers believe that ICD-10 is only about hospital reimbursement. To the contrary, ICD-10 will affect every aspect of a physician’s practice, including patient encounters, clinical and financial workflow, and, depending on circumstances, compensation and reimbursement, as well as future career opportunities. All physician groups will be touched by ICD-10, including surgeons, hospitalists, and physicians in ambulatory settings.

From a high-level perspective, ICD-10 will generate more detailed healthcare data and a greater flow of specific and viable data that improve medical communication, which could contribute to advanced disease protocols and clinical pathways.

ICD-10 is more reflective of the scientific advances that have occurred in medicine in the last 30 years. The code descriptions better describe the gravity of a patient’s illness, which in turn will facilitate validation of a patient’s condition in support of utilization of goods, services, and complex procedures.

On a more individual level, ICD-10 will help physicians create an electronic trail of evidence to receive proper credit and payment for the high quality of care they provide. ICD-9 sometimes lacks any ability for the physician to receive credit for more severely ill patients. As an example, Hemorrhoids in ICD-9 have 10 codes, but only allow the coding of External, Internal, or Unspecified. In ICD-10, hemorrhoid codes were constructed to be clinically based, as the codes follow degree of severity from first to fourth degree. This is only one example where ICD-9 almost prohibits the ability to show why a patient may require more of a physician’s time, goods, and additional tests.

ICD-10 will also help physicians address big technology and healthcare reform initiatives that will impact care delivery and financing, including CMS’ Value-Based Purchasing, Pay for Performance programs (P4P), and coordinated care models such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs).

Additionally, the government’s Physician Quality Reporting System (PQRS), which has the potential to negatively affect physician payments in 2015, along with the move toward adoption of an electronic health record (EHR), makes it even more critical to be ICD-10-ready.

Advancing from ICD-9 to ICD-10 provides crucial public health and disease surveillance organizations, like the Centers for Disease Control and Prevention (CDC), with greatly improved data to handle epidemics such as the swine flu.

All the statistics about such outbreaks are currently derived from ICD-9 data, which is basically out of room to add new diseases and lacks the ability to connect disease manifestations as optimally as ICD-10. ICD-10 will continue this work, but will offer many more levels of data, which will help the CDC, the government, physicians, hospitals, and insurers to identify broader trends, prepare for growing health problems, and view how treatments are working.

For instance, during the outbreaks of the West Nile virus, severe acute respiratory syndrome (SARS), and the first anthrax incident, ICD-9 did not have the codes to describe these events, leading to an inability to report on current numbers and trends. Remember, any time you see the news displaying the number of cases of the flu or the increase in the diagnosis of diabetes, these numbers often are a direct result of ICD-9 reporting. Incorrect information derived from inexact data potentially leads to wrong conclusions and response.

ICD-10 also feeds current scientific healthcare data for epidemiological research and population health management. Over time, ICD-10 data will provide more information on disease progression and treatment efficacy. ICD-10 codes have the potential to yield more information about the quality of care. As a result, this improved data stream will support better understanding of complications, better design of clinically robust algorithms, and improved tracking of patient outcomes.

About the Author

Thomas Ormondroyd, BS, MBA, is vice president and general manager of Precyse Learning Solutions. He oversees Precyse University (www.precyseuniversity.com), an online learning system and program built to deliver education to prepare healthcare professionals for the challenges of today and tomorrow.

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