ICD-10 primer by Ken Ortolon
T
yler family physician Stephen Spain, MD, knows a thing or two about diagnostic codes. As a certi-
fied professional coder, he does all of the coding for his solo practice. That is why he has been paying close
attention to the upcoming implementa- tion of International Statistical Classifi- cation of Diseases and Related Health Problems (ICD)-10 diagnostic codes, scheduled for Oct. 1, 2013, unless the American Medical Association can per- suade the federal government to aban- don its plan for the changeover. (See “The Countdown Begins,” pages 25–28.) Dr. Spain calls ICD-10 “one of the big- gest wholesale changes in medicine to come along in a few decades.” ICD-10 is the first major change in
the U.S. diagnostic coding system since ICD-9 implementation in the 1970s. Ex- perts expect numerous benefits from implementation of ICD-10, including more accurate payment for medical ser- vices, improved ability to measure health care services and conduct public health surveillance, and better data for measur- ing care furnished to patients, process claims, and making clinical decisions. But ICD-10 will come with a hefty
price tag — likely in the billions of dol- lars — as physicians, hospitals, health plans, and others are faced with upgrad- ing practice management software and electronic medical record systems, train- ing staff, and modifying workflow in their offices. ICD-10 will greatly expand the num-
ber of diagnostic codes that physicians will have to choose from when billing Medicare, Medicaid, and private health
plans. The codes will have far more specificity than the current ICD-9 diag- nostic codes, meaning physicians will have to more completely document their diagnoses to support these new codes. Dr. Spain and others say ICD-10 has
huge potential to disrupt the workflow in physician offices and create admin- istrative nightmares if physicians, their office staff, and other clinical practitio- ners in their offices are not ready for the change. But Dr. Spain worries that many of
his colleagues will be ill prepared for ICD-10. “Probably most doctors are not even aware that there’s going to be a change or, if they are, they think it’s go- ing to be nebulous and they’re not going to have to worry about it,” he said. That, he says, would be a huge mis-
take. And a number of organizations including the Texas Medical Association, AMA, and others are urging physicians to start now to plan their transition to ICD-10. “ICD-10 is so much more than just the
number that goes on the super bill or the claim form,” said Rhonda Buckholtz, vice president for ICD-10 training and education for the American Academy of Professional Coders (AAPC). “It impacts pretty much every single area of a pro- vider’s practice.” In spring 2012, TMA Practice Con-
sulting will offer training programs on ICD-10 including documentation para- digm shifts for physicians, as well as programs on code selection, workflow changes, and revenue optimization for staff, says Heather Bettridge, practice management consultant.
In fact, she says TMA Practice Con-
sulting “offers a diverse array of cod- ing and documentation services. TMA consultants offer a wide variation in experience and areas of expertise with certifications as professional coders [CPCs], professional medical auditors [CPMAs], and medical practice execu- tives [CMPEs].”
Getting a late start Actually, the United States, as a whole, is getting a very late start in implementing ICD-10. The World Health Organization ad-
opted ICD-10 in 1993, and more than 100 countries have implemented it. “Physicians need to know that this
isn’t some new coding system that has been developed just for them,” said Gen- evieve Davis, director of TMA’s Payment Advocacy Department. “It’s actually the diagnosis coding system that is used by the rest of the world.” The United States is one of only a handful of countries that have not yet adopted ICD-10, she adds. Some 25 countries use ICD-10 for re- imbursement and resource allocation in their health system. A few of those made modifications to the code set to better suit their health care systems. Some 110 countries use the unchanged inter- national version of ICD-10 for cause-of- death reporting and statistics. The United Kingdom was one of the
earliest adopters of ICD-10, putting it into use in 1995. France adopted ICD-10 in 1997, followed by Australia in 1998, Germany in 2000, and Canada in 2001. But the United States has been slow to put ICD-10 into use. Delays in imple-
February 2012 TEXAS MEDICINE 29
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68