The transition to ICD-10 is arguably the biggest change to the healthcare industry in decades. So it’s no surprise that many physicians are nervous in anticipation of October 1, the day ICD-10 officially comes into effect.
But if knowledge is power, physicians can better prepare themselves for the switch by becoming well acclimated with ICD-10 and learning the best strategies for minimizing workflow disruptions.
1.) What are some of the biggest differences between ICD-9 and ICD-10?
Structurally, the look of ICD-10 is different. We are going from 3-5 numbers for ICD-9 codes to 3-7 alphanumeric characters for ICD-10, hence the reason for the new v.5010 data format mandated last year.
The most significant difference is the dramatic increase in code specificity and the documentation elements that must be captured in order to meet that new specificity. If there is an elevator pitch about ICD-10, it’s basically, “…doctors have to write down more stuff.”
2.) How can practices prepare for the switch to ICD-10?
Besides engaging and motivating their organization for change, the best way to start the transition is to demystify ICD-10 by converting the top 20 or 30 ICD-9 codes to ICD-10 so physicians know the new documentation elements they will be dealing with.
Preparing simple training aids that illustrate these new documentation changes assist providers with empirical education they can understand. Another excellent way to enhance clinical documentation is to conduct simple chart reviews that assess whether or not current documentation will support the choice of a specific ICD-10 code.
Because of payer and vendor response time, it is highly recommended that practices immediately contact these important external stakeholders and determine their state of readiness. These key business partners are critical to the overall success of a practice’s implementation and therefore should be engaged immediately.
3.) What sort of problems might arise for practices as they transition to the new code set?
As with any sweeping new process, practices need to prepare for a loss of productivity. The U.S. is the last industrialized nation in the world to transition to ICD-10. Other countries that have already switched reported an average productivity drop of 20% for the first six months. Canada alone suffered a 50% decrease in coding productivity.
Please keep in mind these are largely single-payer systems with a simpler ICD-10 code set than the ICD-10CM code set the United States will use. Practices may need to cut back on number of patients scheduled, accommodate increased staff overtime costs, and secure short-term loans or lines of credit to weather the storm. Basically, the better prepared a practice can become, the more ICD-10’s impact will be mitigated.
4.) Will reimbursement rates be affected by the change?
Because of the dramatic increase in diagnosis code specificity, it will be critically important to clinically justify procedures and services with ICD-10 codes that meet medical necessity requirements. In other words, the complexity of the procedure or service CPT code submitted needs to be matched by acuity level, or “descriptiveness,” of the diagnosis code.
Continuing to use unspecified ICD-10 codes where more detailed codes exist will result in non-payment.
While contractual reimbursement tied to CPT codes won’t change, the diagnosis code that justifies paying that CPT code will. In the long term, reimbursement rates may actually increase for those practices that create high acuity level profiles. For perhaps the first time, practices can arm themselves with data that can be used in a contract negotiation. For example, it is now possible to say, “The patients I see are sicker than those of my colleague/competitors down the block, and I deserve higher than average compensation levels as a result.”
ICD-9’s lack of detail does not allow for this kind of argument. But ICD-10 does, and practices should make the effort to show the “public face” represented by their data in the best possible light.
5.) How is ICD-10 going to change the way physicians practice?
From a workflow perspective, physicians will need to become very familiar with the new coding and documentation conventions required by ICD-10 in order to minimize the loss of productivity. More time will be needed to learn and accommodate new PM and EHR processes.
Because ICD-10 is just a chip in the overall mosaic of health care reform, physicians need to keep an eye on quality measurements that drive toward new “value based” reimbursement models. Depending on the payer, they may no longer be compensated based on what they do, but rather on how well they prove they do it. This is a significant change in the paradigm and one not possible under ICD-9.
Again, the loss of productivity due to implementing an entire new coding lexicon may result in an inability to see as many patients in a day as they were used to seeing under ICD-9.
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