The 1999 Heath Ledger and Julia Stiles adaptation of Shakespeare’s “Taming of the Shrew” was an entertaining romantic comedy with a simple moral – don’t judge a person on appearance alone. That lesson also applies to our subject today – diagnostic coding. At first the new codes, or at least the thought of changing to the new codes, may not be very attractive, but let's wait until the end of the story to make our judgements.
The looming transition from the use of ICD-9 diagnostic codes to the new ICD-10 codes is set to take place on October 1 this year, and I realize that much has already been written about what hospitals, physicians, and clinical laboratories are likely to experience when the “9” becomes a “10”. But a new version of this coding system shouldn’t be that difficult to learn and implement. I guess the answer to that question really depends on which healthcare provider you ask.
First of all, for those of you who don’t know, there are currently about 14,000 ICD-9 codes being utilized by providers nationwide. Soon, there will be closer to 69,000 ICD-10 codes available. What that means in simple terms is that it’s likely to be much more difficult to choose the right codes for the right clinical scenario, especially early in the transition period, since there are so many more options from which to choose.
The degree of impact on hospitals probably depends on the size of the hospital and the resources available to that institution. Large health systems should have very few issues, except for some minor glitches, while smaller hospitals may not be so lucky. Many anticipate that there will be significant impacts on operations and finances, with the greatest concern being a disruption in cash flow.
On the physician side, major cash flow disruption from large numbers of denials seems likely, and significant revenue damage to smaller practices could be disastrous to them. Some estimates put potential revenue losses as high as 40% in the first few weeks. Staff productivity and patient experience will likely suffer some collateral damage as well.
Since clinical laboratories are indirect providers, the impact on them will still be significant, but it will depend heavily on the physicians they serve. They will need to rely on their physician clients to provide accurate ICD-10 codes on requisitions for the lab tests they order. For that reason, it is critical that labs take the proper steps to smooth the coming transition.
First, it’s up to labs to educate the referring providers about the need to supply the proper comprehensive documentation to comply with the new coding guidelines. Second, the lab staff should understand and share diagnosis coverage requirements for the various payer plans with providers. And finally, they should track errors and noncompliant orders - especially those that impact patient care - and develop reporting metrics that can be communicated with their clients.
So what exactly makes this ICD-10 transition attractive? Well, if we look beyond the “bumps in the road” while providers and coders get the hang of the new system, we may be able to see the silver lining in all of this. Having such a large number of detailed diagnostic codes available will result in an extremely rich data set, which can help us better understand complicated chronic disease states. Better data means better at-risk population health management.
With the addition of more “personalized" genomic data, the understanding of each individual gleaned from the data will become even more significant. We need to continue to drive further adoption of data exchange, strive for information quality improvements, and fully embrace the technology that allows precision medicine to advance. Collaboratively, the healthcare industry can get there and patient care will be much better better when everyone is engaged.
Dr. Charlie Miraglia is hc1's Chief Medical Officer and resident movie buff. You can connect with him on Twitter @ccmiraglia.