Thursday, April 24, 2014

The ICD-10 Emperor is Nicely Dressed and Ready to Go Out

A few days ago, Betsy Nicoletti penned a post titled “The ICD-10 emperor has no clothes.Kate Warnock  - social business strategist at BCBS of Florida – aka @FLBlue - asked me and a few others if we agreed or not.

Here's my response Kate: I largely disagree with Betsy’s post. And here’s why:

1. The howling about the delay of ICD-10 was loud and fierce alright. Albeit a few years late. Where was all this howling from 2008 through 2012 and 2013 when most responsible organizations were diligently working on meeting the compliance date?

2. To me, any proposal that the United States consider adopting the ‘secret,’ paired down, 16,000 code WHO version of ICD-10 must first address the fact that the U.S. uses ICD-10-CM codes for billing and reimbursement. In fact, I’d argue that billing and reimbursement are the primary reasons WHY we must adopt ICD-10-CM codes as soon as possible; existing diagnosis related group and similar reimbursement methods - and new pay for quality and performance reimbursement models - demand the increased specificity ICD-10 provides.

3. I disagree that ICD-10-CM won't provide any benefit to the patient or physician. We need better specificity to enable the promise of “big data.” Clinical risk assessment and assignment needs more granular definition than currently exists under ICD-9. Providers must be more accurately reimbursed based on the diseases and indications they treat. There's a slew of other reasons that many others - including myself - have outlined before. Mine here. And here.

4. I believe that over time, as technology, workflow and AI/natural language process improves, the “selection” and assignment of ICD-10 codes will become automated and the existing 1-3 minutes of overhead will go away. The trend is toward automation and increased productivity using improved documentation.

5. I’m trying to understand the example of conjunctivitis. So why not just ignore those 4 codes believed to be unnecessary? And I’ll offer a reason why the added codes for gout are needed: gout is an expensive disease to treat and causes all kinds of quality of life and ancillary medical costs; primarily via the emergency room. The expectation is that additional ICD-10 specificity supports better research and treatment options - for gout and many other diseases and medical conditions.

6. The codes for injuries and accidents are important to help assign responsibility and clarify the nature and extent of accidents and injuries caused by 3rd parties. Other party liability is an important area to address so that overall healthcare costs and responsibility are properly assigned.

7. One comment I’m having a hard time wrapping my head around is the statement that “the physician typically selects the CPT code and the diagnosis codes that were the reason to provide the service.” I suppose this may be true for small practices and those with limited services. But is this really true for most “practices?” I’ve asked just about every doctor I encounter and most laugh and say “No, my so and so does that” or “I use a billing service that codes from my charts.” So while I understand that the need for coding doesn’t go away if the physician is not involved, there is a division of labor down to a less costly resource. I'd like to see some confirmed statistics on how many physicians code their own claims and the diversity of their clinical documentation and codings.

So while I do agree that ICD-10-CM does contain some needless specificity, I don’t agree that's a reason to abandon ICD-10 altogether. And I do not see the ICD-10 Emperor as being naked but rather nicely dressed and ready to go out.

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