Face the ICD-10 delay with optimism instead of skepticism

 

The April 1 confirmation of the delay in implementing the ICD-10 code set certainly took the wind out of many healthcare organizations sails. Just last week, CMS released a statement setting the new implementation date as October 1, 2015.

 

Those organizations spent countless hours and dollars preparing for the go-live date less than six months away. At the present time, many organization may feel as if they are being penalized for planning and being proactive. The healthcare industry has spent billions preparing for ICD-10, so this leaves all of us with questions. Do we invest more in ICD-10 implementation or will it eventually be squashed?

 

Rest assured, many organizations support ICD-10. The biggest of which, the Coalition for ICD-10, is made up of the following organizations:

 

With good reason, the repeated delays have made providers hesitant to keep investing more in ICD-10. Some articles tout that this delay gives us a much-needed extra year to prepare, but to be honest, wasn’t that the same argument we heard when it was postponed from 2013 to 2014? Sounds more to me like procrastinating on the inevitable. Organizations have prepared too  much for ICD-10for the U.S. to just opt to never transition.

 

Many organizations have experienced (to use a military term) “hurry up and wait” once with the first delay. At that point, it was somewhat welcome, because I think we did ultimately need more time. But to hear another delay six months prior to implementation is flat-out disheartening. I know many don’t want to do it all over again, just to find out that it is being pushed back again or, worse yet, not being implemented at all.

 

 

For those spearheading the delay (or, should I say, pushing for a permanent delay), it hasn’t been as big an issue. Recent surveys by Navicore and MGMA show that many providers and physician coders have yet to even start training for ICD-10. For them it isn’t starting over or refreshing their staff. It’s starting in general, which is a big difference.

 

On the other hand, many hospitals have done at a bare minimum basic ICD-10 education. Most are probably much further along and are in the testing/dual-coding phases, so they are discouraged to learn the new system, which many find much better than ICD-9, is being delayed.

 

I have been doing ICD-10 training for more than three years now and a common comment is that many wish they could just use it now. To quote Denise Buenning, acting deputy director of the Office of E-health Standards and Services at CMS, “If it’s not an adopted code set, it’s not allowed.” So for those who want to just use it anyway, that’s not an option.

 

 

It isn’t a secret that the American Medical Association (AMA) has been quite vocal about not implementing ICD-10. I had to admire the brutally honest speech made by Steven Stack, MD, at the AHIMA ICD-10/CAC Summit April 22-23 and the confession that the AMA wasn’t trying to delay ICD-10, it was trying to “kill it.” This statement made in the company of strong advocates for the implementation of ICD-10 was bold, but quite admirable.

 

I’m not surprised that the physician community views ICD-10 as futile and worthless, considering much seen on the news surrounding ICD-10 is about codes that are mostly optional. I know the external cause codes—such as whether a patient was struck by a chicken (W61.32xA) or pecked by a chicken (W61.33xA)—seem like a perfect formula for an entertaining presentation, and certainly guaranteed laughter. But the bottom line is, this code set includes valuable codes that don’t seem to ever get their day in the spotlight.

 

External cause codes are mostly used for statistical purposes, but in some instances help establish liability surrounding an injury. I just came across a very sad, but relevant, code in the ICD-10-CM code set for drowning/submersion due to a passenger ship overturning (V90.01xA), which includes a ferry boat. I pray we never encounter a tragedy like South Korea did recently, but ICD-10-CM includes a code for those victims to identify the circumstances of this tragic event.

 

Some codes within this series can possibly affect payment, such as the place of occurrence codes for a hospital (Y92.23- series). Falls are the most common hospital-acquired condition (HAC), and these codes provide the detail of where the fall occurred (corridor, patient bathroom, cafeteria, etc.). Even these seemingly insignificant codes have a value that extends beyond what ICD-9 can offer.

 

By and large, most coders are not going to delay submitting a claim because the provider did not state which room in the house the person was in or what type of home they lived in (single family versus a mobile home). Or even if they were struck or pecked by a chicken.

 

Providers don’t use all of the codes in the ICD-9-CM code set, so I am not sure why the presence of additional code options has become so problematic. Do we need all of them? Maybe not, but we don’t use all we have now anyway. If the situation arises, in ICD-10 there is likely a code for it.

 

 

ICD-10-CM diagnosis codes will require the least amount of training because the code set is very similar to the current ICD-9-CM Volumes 1-2.

 

The providers who are adamantly opposed to ICD-10 altogether may have heard information similar to what I recently read in an article. The physician stated he was opposed to ICD-10 because he would have to basically take two weeks off practicing medicine to learn the new code set or, at a minimum, learn the documentation differences between ICD-9-CM and ICD-10-CM. If a coder can learn the primary differences in the new code set in the suggested 16 hours, I have faith that it will not be as time consuming as providers may be led to believe.

 

We have approximately 14,500 diagnosis codes in ICD-9-CM, but will have approximately 70,000 in ICD-10-CM. Technically, two of the major differences in the ICD-10-CM codes should be something inherently documented by most providers without much coaching: laterality and trimesters (for obstetrics). These two things account for a vast number of the increase in code options.

 

If you think about how many body parts you have that are bilateral, there are more of them than not. So for one ICD-9-CM diagnosis code, ICD-10-CM includes at least three options (right, left, and unspecified). For some categories, there is even a fourth option for bilateral. The addition of laterality alone gets us to about 75% of the increase in codes. Obstetrical codes in Chapter 15, Pregnancy, Childbirth and the Puerperium (O00-O9A), generally have at least four options to identify first, second, third, and unspecified trimesters.I bet we’d find they account for a fair number of the increase of codes that involve minimal effort or change needed.

 

One important improvement in ICD-10 that rarely gets mentioned is how the new system will improve tracking efficacy of treatment methods and outcomes by having a more specific code set for procedures.

 

Those who have learned ICD-10-PCS, even on a very basic level, know that this code set is more worrisome. It is a completely new way of coding procedures and he AHA’s Coding Clinic for ICD-10-CM/PCS has provided very little guidance to date.

 

The AHA will remain true to the current course, stating “the plan not to address any ICD-9-CM questions is still in effect until such that the Cooperating Parties decide to lift this ban. The AHA Central Office will continue to provide advice on ICD-10-CM/ICD-10-PCS.”

 

I do hope that with the added time due to the delay we will receive more guidance on a broad scale to address the many questions coders have regarding ICD-10 (procedures specifically). The AHA has been accepting questions for years on ICD-10-CM/PCS, but has addressed a very limited number of topics. I am somewhat surprised considering the vastness of the change in thought process to assign an ICD-10-PCS code.

 

However, the procedure codes capture different approaches for all procedures (not just selected ones like in ICD-9-CM), as well as identifying implantation of devices, both of which are helpful to track outcomes.

 

The structure of the code set allows for easy expansion to identify new technology, which in medicine is almost like trying to get the most up-to-date computer. As soon as you buy one, the next best thing is coming out. For years, providers have complained about not having specific procedure codes in CPT for all the variations on procedures they perform. ICD-10-PCS hopefully will provide many of those options for the facility. Coders will continue to report the CPT codes for physician services even after implementation of ICD-10-PCS.

 

Physician coders did technically get the better end of the deal than inpatient hospitals, because they only need to learn ICD-10-CM. Despite that, physicians have been one of the most vocal groups opposing ICD-10 implementation.

 

The new code sets offer so much value and includes much more than the running joke involving external causes. Misinformation leads to skepticism, but those who understand coding know and understand the value of the ICD-10 code set. We must continue the course and take a stand in support of ICD-10. Strength in numbers!