The popular approach to writing anything about ICD-10 conversion these days is to describe the disastrous impact providers say it will have—or is already having—on healthcare, nearly two years ahead of its launch.
From the sound of it, everyone from physicians to nurses to CFOs and CIOs must be preparing for hell itself, or at least stocking up on awesome quantities of Pepcid.
Peter Carmel, MD, president of the American Medical Association, and flocks of physician groups speak of its "onerous" burden, costing each physician $28,000, on top of the reimbursement cuts and other changes they already face.
It's another unfunded mandate with no clear benefit leading to access problems for patients, says Diane Bristol, OB-GYN legislative liaison for the Medical Group Management Association in Midland, MI.
I get it; ICD-10 means headaches, money, and time. But I write about quality, so I'm going to damn the torpedoes and talk about the whole point of this undertaking, which is, after all, to improve quality.
The decision to require the transition to ICD-10 was made years ago. Federal agencies and providers developed the U.S. version together with documentation showing that ICD-10 code sets will improve our understanding of why we get sick and how we give care.
ICD-10 will increase the number of procedure codes from 4,000 to 72,000, and the number of diagnosis codes from 14,000 to 69,000. Sue Bowman, one of several ICD-10 cognoscenti who shared her expertise with me, says most physician practices will use only a small set of these codes, so it's really not so draconian.
So tune out all the sobbing, screaming, and procrastinating and focus on 10 reasons why ICD-10 will prove to be a good thing, eventually:
1. Updates to current terminology and specificity
ICD-9 was developed in 1979, a time when terms like laparoscopic, endoscopic or thoracoscopic were unheard of in surgical suites. "Our ICD-9 system is ancient," says Bowman. Take the structure of disease management codes for asthma, she says. "It's either intrinsic or extrinsic asthma, which doesn't match the clinical classification currently in use, that is persistent, or intermittent," or any number of other types.
"When you think about the fact that this system is now over 30 years old, and you think of the state of medicine in the 1970s... you realize it's not surprising that there's a lot of these problems (within ICD-9) that structurally just can't be fixed," she says.
2. Improves public health tracking
ICD-10 improves the ability of public health officials to track diseases and threats, dangerous settings and even acts of bioterrorism that might otherwise go unrecognized.
It "is more specific and fully captures more of the public health diseases examined than ICD-9," says a paper by Valerie J.M. Watzlaf, [PDF] professor of health information and management at the University of Pittsburgh. Information was better for capturing reportable diseases, the top 10 causes of death, and illnesses related to terrorism.
For example, ICD-9 has no way of classifying certain serious foodborne illnesses, such a clostridium perfringens, but ICD-10 does. And ICD-10 is much more specific about syphilis, HIV and pneumococcal infections.
3. Discourages upcoding, fraud
One potential for ICD-10 is that with more specificity, it will be a lot tougher for hospital coders to lump patients into a more severe disease or procedure category. Bowman says, "In an ICD-9 world, codes are more ambiguous," says Bowman.
"It will be harder for people to, when they encounter something that seems initially like it's on the border of one code or another, to say, 'I think I can get this into this (higher paying) code.' We'll be seeing a lot less of that with ICD-10."
For example, ICD-10 features a way of identifying each side of the body. Bowman says that if a patient seems to be having numerous procedures on the same foot, either the treatment "isn't effective" or it may be a billing misadventure, she says. "It helps with fraud, because payers can check for multiple encounters/treatment for the same anatomical site."
4. Specifies reasons for patient non-compliance
As providers are increasingly held accountable for patient outcomes, a huge concern is how to classify the patient who fails to follow a recommended regimen of care and gets sicker as a result.
Under the current code, there is only one code for such a patient. But in ICD-10, there are at least eight. For example, one of the eight codes indicates these variations:
- "Intentional underdosing due to financial hardship,"
- "Unintentional underdosing due to age-related debility"
- "Non-compliance with renal dialysis"
5. Allows for detailed data on injuries, accidents
One of the most interesting quality improvement potentials of ICD-10 is what it reveals about injuries, such as where they occur, what part of the body was injured, and what implements were used, alerting providers to common dangers.
For example, there are nine codes to describe mishaps involving baby strollers, such as a fall or collision with a stationary object.
How specific? There's a code for an injury involving digging with a shovel. There are codes to identify injuries due to toxic effects from ingesting fiberglass, being injured by a lamppost, or being burned while on water skis.
And there are copious codes to identify injuries involving non-human animals, including 14 for mishaps involving a horse.
6. Tracks healthcare-associated conditions
The ICD-10 code allows much greater explanation and accountability for adverse events that can occur within healthcare institutions. For example, there are at least 50 categories for a foreign object, whether the patient came in with it or not. And if a fall or other mishap occurred within a hospital, the location is specified as the bathroom, cafeteria, corridor, the operating room or the patient's room.
7. Specifies procedures by degree of difficulty
The new codes allow certain procedures to be subdivided by difficulty. Bowman says that under ICD-9, there is only one code for artery suture, but in ICD-10, there are 195: Four different approaches and 67 possible arteries. Though some are far more difficult than others, under the current code set, they are all lumped together.
8. Allows for more precision in reporting complications from medical devices
In the current system, a patient death or serious disability due to a device malfunction or breakdown is classified as 996.1: Mechanical complication of other vascular device, implant, and graft.
ICD-10 allows providers to be much more precise in describing the nature of the malfunction. The new code differentiates whether there is a mechanical breakdown of a vascular dialysis catheter, an arteriovenous shunt, a balloon counterpulsation device, or an umbrella device.
9. Creates jobs
Conversion to ICD-10 will create jobs for coders and trainers, many of whom may transition from other jobs soon to be cut to reduce costs. While this may not directly improve quality, fewer lost jobs may lessen the toll on employee morale that major layoffs could provoke. And employee morale can be linked to quality and patient experience scores.
10. Aligns with EHR
The transition to ICD-10 will assure that electronic medical records, value-based purchasing metrics, and meaningful use incentive programs speak the same language.
Feel better? I hope so. After all, ICD-10 is supposed to be all about quality of care, isn't it?