Health Information Management

Why is ICD-10 so scary--or is it?

JustCoding News: Inpatient, July 18, 2012

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Editor’s note: This article is part one of a two-part series.

Let’s be honest. Any significant life change brings with it some type of uncertainty—it’s that fear of the unknown. Many of us approach transitions with trepidation. The transition to ICD-10, which has been looming for years, is no different.
Coders, in particular, may even fear ICD-10. Many coding professionals ask themselves these questions:
  • How can I prepare for the change?
  • What will the change mean for me?
  • Will I be able to adjust to the change?
  • How will my job be different after the change?
It’s not surprising that coders are worried about the transition to ICD-10. That’s because their apprehensions are deeply rooted within a larger culture of fear, says Robert S. Gold, MD, CEO of DCBA, Inc. in Atlanta. “There are fears all over the hospital about ICD-10. It’s not only the coders,” he says.
Chief financial officers fear that hospitals will lose money, says Gold. IT staff fear of how—or whether—the electronic health record (EHR) can accommodate ICD-10 and its documentation requirements effectively. Physicians fear how their own reimbursement may be affected. Hospitals nationwide are spending millions of dollars to hire consultants who perform ICD-10 readiness audits. Organizations do this partially out of fear because they simply don’t understand the new coding system, he adds.
The good news is that coders are resilient individuals who will not only survive the transition to ICD-10 but also thrive as a result of the new code set with which they’ll work, says Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, president of Safian Communications Services, Inc. in Orlando.
“Every one of us has lived through major changes and overhauls in our lives that have been scary and disruptive, especially when the changes are related to work,” she says.
Are your fears rationale or irrational?
Some coders fear ICD-10 simply because of the sheer volume of codes in the new system.
Can you blame them?
The media contributes to this fear by reiterating the ‘seemingly insurmountable’ code expansions as well as highlighting the differences—rather than the similarities—between the two coding systems, says Safian.
It’s important for coders to look beyond the volume and appearance of the codes. Doing so reveals that ICD-9-CM is virtually identical to ICD-10-CM, she adds.
ICD-10-PCS, on the other hand, is what some coders fear more because it’s so drastically different from ICD-9 Volume 3, says Safian. “There is a bigger learning curve because coders will use terminology in a different way. You’re actually building a code to match what the doctor wrote,” she says.
For example, in ICD-9, coders can locate a code for a biopsy in the Alphabetic Index under the letter ‘B.’ However, in ICD-10-PCS, this procedure is considered an excision (cutting out or off, without replacement, a portion of a body part). A thyroidectomy is considered a resection (cutting out or off, without replacement, all of a body part). Removal of a tumor from within an organ (without removing any part of the organ itself or the organ in its entirety) is considered an extirpation (taking or cutting out solid matter from a body part)—not a removal. In ICD-10-PCS, the term removal refers to the removal of a device.
“It’s a new way of looking at things,” says Safian. Although coders will need to translate information differently, they’ll continue to use their keen eye for detail and logic as they always had in the past, she adds.
Coders also fear they won’t be able to afford the training they’ll need to be able to code effectively in ICD-10, says Safian. Remember that not all coders need to become AHIMA-certified ICD-10 trainers, which can be a costly process. Coders can attain an affordable ICD-10 education that provides a working knowledge of the new system. Taking an ICD-10 course at a local community college or online as well as reading a book about ICD-10 coding requirements can go a long way in terms of learning the new system. Coders can—and should—ask their employers about a full or even partial reimbursement for these resources, she adds.
Coders who fear of insufficient training or difficulty using the new codes may suffer other uncertainties. In particular, coders may fear that they could lose their job if they can’t keep up or learn the new codes, says Safian. They convince themselves that they’ll never learn ICD-10, which means that no one will employ them, she adds.
Other changes associated with ICD-10 are also scary for coders, says Gold. For example, hospitals are starting to implement computer-assisted coding to help with the transition, and some coders see the technology as a threat to their job security. “Don’t be afraid of computer-assisted coding. It’s not a threat to the coder at large,” he says.
Coders also fear that physician documentation will not include the information coders need to assign an ICD-10 code. Some coders fear that increased queries will only create more tension with physicians, says Safian. However, coders must realize that documentation does usually include the relevant details needed to code in ICD-10. If hospitals start to develop a plan to incorporate new information into documentation templates now, the transition will be much easier, she adds.
Know that physicians have fears, too
Gold acknowledges that all physicians are anxious about how ICD-10 will affect their ability to bill for professional services. He says physicians are accustomed to circling an E/M code in conjunction with one of a handful of diagnosis codes that can easily fit on a paper or electronic superbill when they provide inpatient services. However, ICD-10includes many more codes . No tool currently exists to help physicians choose the correct code, and physicians fear that incorrect choices will lead to decreased payments or no payments at all, he says.
“With severity-adjusted payments to physicians, physicians will need to provide the same added specificity and accuracy that hospitals must provide. There is no product out there that provides that specificity for the physician with the exception of those that use an extensive ‘pick list,’ which can be terribly burdensome,” he says.
Stay focused on clinical documentation improvement (CDI) both now and after the implementation of ICD-10, says Gold. “If the docs are ready for ICD-9, they’re ready for ICD-10,” he says. The effective and compliant strategies on which CDI programs are built shouldn’t change after the new coding system goes into effect, he adds.
The AMA’s resistance to ICD-10 reinforces coders’ fears about how receptive physicians will be to add any new information coders ask them to document or clarify, says Safian.
Physician resistance also makes it difficult for coders to shift their own mindsets and start preparing for the change because physician cooperation is such a large part of that change, says Safian. Some physicians are simply denying the transition entirely rather than addressing how it will affect them. “I think that panic runs downhill. Even physicians aren’t addressing what they’re really afraid of,” she says.
Coders should keep in mind that the AMA only represents 11%–19% of physicians, says Gold. Coders shouldn’t assume that all physicians—or even a significant percentage of them—are resistant to ICD-10, he says.
Take initiative to address fears
One of the most effective ways in which coders can prepare for ICD-10 is to open the lines of communication with physicians, says Safian. Use ICD-10 as an impetus to ask physicians for feedback about the query process. Hospitals can then implement any necessary changes prior to the implementation of ICD-10, she adds.
“Coders are sometimes very afraid of querying the doctor because they’re afraid that they’re going to make the doctor angry. They’re afraid that if they say it in the wrong way, the doctor will be insulted,” Safian says. Coders may be more comfortable approaching physicians with ICD-10-related questions if they know that physicians have been able to provide input into the query process in advance.
Coders should also begin to work with surgeons to develop templates for the most frequently performed surgeries, says Gold. The templates should include information needed for both ICD-9 and ICD-10 so that physicians simply need to insert specificity where it’s required, he adds.
Gold says the ICD-10-PCS manual includes all of the information that coders, nurses, and CDI specialists will need when creating these templates. In particular, the manual includes tables that describe how each ICD-10-PCS code must be constructed. If physicians don’t currently document any of the details described in the tables, coders should note that information and ensure that it’s added to a template for the procedure. It’s a tedious and detailed task, but it’s something for which coders are particularly qualified, he says.
“The HIM department should absolutely be involved in this,” says Gold. “This would create so much more free time for coders and physicians, and everyone will be totally ready for ICD-10.”
Editor’s note: Lisa A. Eramo is a freelance writer and editor in Cranston, RI who specializes in healthcare regulatory topics, health information management, and medical coding. You may reach her at

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