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Benefits of ICD-10


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The transition to ICD-10 means a lot of work for many people, however, what some might not realize are the many advantages the new coding system offers. The Benefits of ICD-10 report discusses the …

The transition to ICD-10 means a lot of work for many people, however, what some might not realize are the many advantages the new coding system offers. The Benefits of ICD-10 report discusses the advantages and will familiarize you with the positive impact the new coding system has and provides an optimistic outlook on the transition to jumpstart you and your organization into the preparations required in order to hit the October 1, 2014 deadline. - Get the report at -

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  • 1. Benefits of ICD-10: The Case for Change by Lawrence Pawola, PharmD, M.B.A. Director of the Department of Biomedical and Health Information Sciences, University of Illinois, Chicago; Board of Directors, Phoenix Health Systems
  • 2. Why Move to ICD-10? During the past few years, I have been asked on a number of occasions why the transition from ICD-9 to ICD-10 is so important, what is to be gained from the transition, and why now, particularly given the anticipated work to affect the transition and the general thought process that it is another government intrusion akin to Meaningful Use, among others? As prelude to my response, I will point to the independent study by the Rand Corporation (1) concluding the benefits of the ICD-10 transition will outweigh the implementation costs within a short time for most organizations, but the cost of doing nothing may be far greater than the cost of the work to complete the transition. As healthcare becomes increasingly more electronic and the costs of any future change will most certainly involve more complex systems, any further delay in the transition will only become more expensive. If ICD-9 has served the industry so well for so long, why change now? Simply stated, ICD-9 has not been able to keep up with modern medicine and the advances in medical technologies. The old coding system is exhausted. 2Benefits of “The cost of doing nothing may be far greater than the cost of the work to complete the transition.”
  • 3. Since the United States is the only industrialized nation in the world not utilizing ICD-10 or a similarly detailed coding scheme, we are having an increasingly difficult time accurately measuring the quality of care provided in our healthcare system. It is becoming more costly and complicated to adequately assess a patient’s condition and evaluate treatment outcomes when we don’t have the availability of a clear- cut and well-defined coding system. Perhaps even more important is our duty as medical workers to continually improve the quality of care we deliver to our patients, to reduce our errors, and to enhance our decision-making with more accurate data available at our finger tips. Add the opportunities of using improved and more defined data for research purposes and more quickly defining fraud and abuse cases, one can readily see why ICD-10 or a similarly detailed coding scheme is prevalent throughout the world. If our healthcare delivery system is so good, and we in the United States like to think we are the best in the world, then why are we resisting this change? Is it because we don’t understand the benefits of the transition? Or are we looking at ICD-10 as a checkbox on an ever growing "to do" list rather than a strategic opportunity for our organization? This is not a new revelation. The inadequacies of ICD-9 were widely recognized over 20 years ago when The National Committee on Vital and Health Statistics (NCVHS) testified to the Department of Health and Human Services (HSS) the difficulties of ICD-9 in keeping up with the rapid pace of advances in medical science. Why has it taken so long? Benefits of ICD-10 3 Why ICD-9 Falls Short
  • 4. The Basics. The diagnosis side for ICD-9-CM (Clinical Modification) has about 13,000 codes compared to 68,000 codes for ICD-10-CM. A big chunk of this expansion is due to the increased specificity in the ICD-10-CM coding scheme. There are codes, for example, for right eye, left eye, bilateral eyes and unspecified whereas in ICD-9-CM these are all in one code. For the procedure side, there are about 3,000 volume 3 ICD-9-CM codes; in ICD- 10-PCS (Procedure Code System), there is a potential of about 72,000 codes. 4Benefits of
  • 5. Simply stated… More codes means more defined, and better, differentiation of procedures to more accurately document technology advancements. This has become a most noteworthy problem in many medical specialties where new procedures, technologies, devices, and treatments are being used; many ICD-9 categories don’t have any additional room for more codes. Just ask the HIM professionals to discuss the difficulties they have accurately coding recently introduced and more advanced orthopedic and cardiovascular procedures, among others. The new ICD-10 codes should then translate directly into: • More precise reimbursements • Improved reporting • More detailed outcome data for the providers • Fewer claim rejections or requests for additional data • Diminished need for manual reviews of records in order to meet the information demands of reporting agencies. For the payer, this means more accurate and detailed medical coverage while providing better management of reimbursements to the patient. 5Benefits of
  • 6. The Case for Better Data Because of increased levels of detail and accommodation of new procedures and technologies, ICD- 10 can supply better data to measure and assess the quality of care delivered to our patients. 6Benefits of As clinicians, we will be better able to understand adverse events and complications which will assist in identifying treatments to improve our patients’ outcomes. Our ability to mine data for further analysis and identification of trends while promoting safety and other best practices will be improved. The new codes will further connect a provider’s performance to the patient’s overall condition and outcome; the resulting impact on malpractice and insurance rates at both the personal and organizational levels may be unprecedented. Accurate and comprehensive procedure codes will upgrade the data available to determine outcomes, treatment efficacy, and overall costs incurred from using new medical technologies. In its purest form, these will lead to better care being provided as well as more thoroughly identifying and monitoring patients in need of additional interventions or disease management programs.
  • 7. An often overlooked aspect of the ICD-10 transition is the opportunity for comparing care and best practices because of a more granular standard of data capture being utilized. This benefit alone will better support the medical community’s thrusts to improve performance and contain costs. All providers will now be able to better monitor resource use, analyze healthcare costs at a greater level of detail, and monitor outcomes relative to overall costs. 7Benefits of
  • 8. Public Health Benefits In this era of increased awareness, and because the United States has not been using ICD-10 or a similarly detailed coding system, we cannot very easily share disease data internationally. For public health reasons, such sharing is essential to adequately respond to emerging global threats. Public health emergencies must be communicated to local agencies and internationally to the World Health Organization (WHO) in order to rapidly detect, verify, and respond in an appropriate manner to threats so any impact is minimized. Generally speaking, ICD-10 is more valuable documenting public health clinical data than other coding schemes; its specificity captures more reportable public health diseases, particularly those related to substantial mortality and bioterrorism (2). 8Benefits of
  • 9. Improvements in Research Because of the finer detail contained in ICD-10, fewer coding errors will be realized which will improve the data available for research purposes. The greater detail will provide researchers with more opportunities to uncover formerly unidentified data relationships. For instance, knowing if one less invasive procedure has similar or better results at a lower cost than another more extensive procedure would greatly affect the quality of care in our country while potentially saving a considerable amount of money. Further, better coding classifications for injury severity, mortality risk, and other population-based data is essential for outcome research in addition to identifying better prevention and treatment follow-up programs. 9Benefits of
  • 10. Summary The transition to ICD-10 represents an improved mechanism to record the care delivered to our patients consistent with the opportunities afforded to our industry from the implementation of more extensive and better clinical technologies. The cost of not transitioning to ICD-10 could be staggering, not to mention the cost of lost payments and opportunity. The data available from the use of ICD-10 will dramatically advance our nation’s healthcare system in a number of critical ways while delivering the benefits identified above while reducing the risks of fraudulent reporting. The transition to ICD-10 must be viewed more broadly than merely complying with another government regulation; rather, it is an opportunity to differentiate and strategically use the data to create greater value for our society in terms of higher quality and reduced costs. In that is the true benefit why the transition to ICD-10 is important for everyone. 10Benefits of
  • 11. Appendix (1) Rand Corporation. “The Costs and Benefits of Moving to the ICD-10 Code Sets.” March 2004. Available online at RAND_TR132.pdf. (2) Watzlaf V., et. al. “The Effectiveness of ICD-10-CM in Capturing Public Health Diseases.” Perspectives in Health Information Management, volume 4 number 6 (2007). Available online at 11Benefits of Need help with your transition to ICD-10? Contact us!Phoenix Health Systems, Inc. 1130 East Arapaho Rd, Suite 500 Richardson, TX 75081 ph: (214) 261.0660