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Dispelling Some ICD-10 Myths
By Stuart Newsome, CHCC

Myths and urban legends flourish in an array of settings—business, sports, storytelling, and even healthcare. They may not all be as famous or as colorful as the legends of Sasquatch and the Loch Ness Monster, but myths even abound as part of the change from ICD-9 to ICD-10 coding, scaring off providers and others from taking the plunge to transition.

With the ICD-10 deadline in a state of limbo, hospital leaders are wise to stay the course on this major initiative. To help bring forth some much-needed momentum, it is important to explore some of the myths circulating and dispel those that may be keeping providers and others from moving forward on ICD-10.

Myth 1: Coders and physicians will have to learn thousands of new codes, including legendary outrageous codes.
The diseases aren’t changing. The codes on how to report them are changing to become more specific and dependable. Users won’t necessarily have to learn more new codes, but they will have to change ingrained habits on how to access more powerful and specific codes.

Coders will need to beef up their knowledge of anatomy and physiology, and physicians will be required to shore up clinical documentation that translates to effective coding. Vague descriptions of conditions by physicians and rote memorization by coders or taking a stab at what they think is the correct code will no longer suffice with ICD-10. Physicians will need to use more specific nomenclature in documentation so coders can locate the precise ICD-10 code that matches the medical condition. Changing the processes that have become routine for many physicians will likely be one of the biggest hurdles. This obstacle, though, can be easily cleared with proper training and preparation.

The specificity of some of the new ICD-10 codes have provided some levity, but their precision (eg, right or left side of the body, setting of an injury) is one of the strengths of the new coding system. With a more granular system, coders will need to make fewer judgment calls. Because ICD-10 is less arbitrary, trained coders should be able to deduct the correct codes more effectively. But training for staff—as much as 50 hours—is critical and cannot be overstated.

Myth 2: ICD-10 and EHR implementation are competing initiatives.
Some healthcare professionals are avoiding the task of transitioning from ICD-9 to ICD-10 because they are confused about priorities and feel caught between competing initiatives. Some think the ICD-10 timeline has historic precedence over the meaningful use requirements and if any mandates should be delayed, it should be meaningful use. But implementing EHRs, attesting to meaningful use, and transitioning to ICD-10 are closely aligned and complement each other. These initiatives together should be considered as a comprehensive package to improve documentation efforts.

A speedy, efficient EHR can ease the ICD-10 implementation. EHRs may streamline the coding process by functioning as coding crib sheets, providing boundaries and helping providers select the most appropriate code. Transitioning to ICD-10 ensures that EHRs, value-based reimbursement, and meaningful use incentive programs all speak the same language.

If the goal of EHR initiatives is improving the quality of patient care, ICD-10 does nothing but enhance the process, as its specific descriptions more accurately indicate a patient’s condition and help track progress and outcomes more effectively.

Myth 3: ICD-10 has no benefits for stakeholders.
On the contrary, everyone wins with ICD-10—from providers to patients. As mentioned, the specificity of ICD-10 is its forte. The use of ICD-10 will provide more detailed, reliable coding to support more accurate payment, thus enhancing reimbursement.

Because it facilitates more accurate diagnoses, ICD-10 enhances patient outcomes, supplements evidence-based research, and improves public health tracking and population health analysis. The better overall comprehension of patient- and population-level health metrics, the more precision can be used in describing the nature of disease, and the better comparative studies can be made on the effectiveness of treatments.

Because it provides greater delineation, ICD-10 improves disease management. For example, more than 250 ICD-10 diabetes-related codes distinguish among type 1 and 2 diabetes, gestational diabetes, and diabetes caused by various medications or underlying conditions. This information is helpful to more effectively manage this chronic disease.

As providers become more accountable for patient outcomes, less ambiguous coding will help specify reasons for patient noncompliance. For example, with ICD-9 there is only one code for patients who fail to follow a recommended regimen of care and become more ill as a result. ICD-10 stipulates at least eight codes, covering such situations as financial hardship and age-related debility.

ICD-10 provides more details on injuries and accidents, revealing where accidents may occur, what part of the body was injured, and what implements were involved, thus signaling common dangers to providers. Because of its specificity, ICD-10 helps track nosocomial infections and other healthcare-associated conditions, helping hospitals determine more accurately where falls or other mishaps occur. Enhanced documentation of a patient’s condition will improve shared data with health information exchanges, facilitate auditing efforts, and decrease fraud and abuse.

Additionally, ICD-10 helps streamline workflow in some areas—for example, separating codes by trimester to parallel how physicians assess obstetrical patients, thereby eliminating the need to manually search through all the codes.

In summary, the ability to leverage ICD-10’s greater granularity will help increase reimbursement, establish more effective processes, and improve healthcare quality, patient safety, and population health management, thereby tremendously benefiting all stakeholders.

Myth 4: The time is not right for the transition to ICD-10.
The time is not only right to transition to ICD-10, it’s long overdue. ICD-9 was created in 1979—before the identification of SARS (severe acute respiratory syndrome) and HIV and the use of robotic surgery, to mention only a few diagnostic and technological developments that have occurred in the past 30 years. The United States needs coding that matches recent medical discoveries and aligns its healthcare system with other developed countries that adopted ICD-10 years ago.

Even though the Centers for Medicare & Medicaid Services is shifting the schedule, the time is right to switch to ICD-10. Those contemplating waiting and leapfrogging directly to ICD-11 once it’s ready should reconsider. ICD-10 is the pathway to ICD-11, and any planning done now for ICD-10 will not go to waste. Discerning fact from fiction will only put providers in a stronger position to gain clinical and administrative efficiencies and enhance revenue.

— Stuart Newsome, CHCC, vice president of business development at Unicor Medical Inc in Montgomery, Alabama, has spent 16 years in medical coding.