Health Information Management

Associate Director's Note: ICD-10-CM/PCS future looks bright

CDI Strategies, February 19, 2015

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Last week’s congressional House Energy and Commerce Committee subcommittee hearing regarding ICD-10-CM/PCS implementation left many industry leaders optimistic. Of the seven witnesses who answered committee questions and provided testimony, only one spoke against implementation, essentially reiterating old, erroneous, arguments. (Read the testimony and watch the hearing online).

“This hearing was a big win for us,” Kristen Saponaro, Vice President of Marketing for Precyse in Alpharetta, Georgia, told a special session of Talk Ten Tuesday regarding the hearing. “Even those members who voiced criticism indicated that they want to move forward [with ICD-10 implementation].”

The concerns critics did express were rooted in worries over implementation and process, and not with the code set itself, Saponaro explained. And that, “really demonstrates the hard work everyone has done collectively” to educate the general public about the benefits of the code set and to debunk commonly held code set and implementation myths.

Discussing ICD-10’s effect on quality of care and population health helped debunk one such myth, that excessive new codes add meaningless information and additional documentation for physicians—the old attacked by a killer whale argument.

Another rumor, the expense of implementation for physician practices, is slowly eroding as multiple studies pin costs significantly lower than earlier estimates. One such study, generated in cooperation with Professional Association of Health Care Office Management (PAHCOM), and published in the February edition of the Journal of AHIMA, garnered responses from 276 practices with six or fewer providers. These practices reported that average ICD-10-related expenditures for the entire practice cost $8,167 with average expenditures per provider of $3,430. A similar November 2014 report put transition costs at roughly $2,000 to $6,000 for small practices (three physicians).

Additional concerns regarding CMS’ own readiness to work within the code set may have been alleviated with a recent report from the Government Accountability Office (GAO). The GAO says CMS has prepared for the transition by:

  • Developing educational materials for HIPAA-covered entities (CE); i.e., facilities and physicians, and vendors
  • Conducting outreach, including holding on-site training for some small physician practices
  • Organizing stakeholder meetings, focus groups, group testing, and surveys to monitor CE and vendor readiness
  • Changing Medicare fee-for-service (FFS) claims processing systems
  • Providing technical assistance for Medicaid agencies

Although the GAO did raise some concerns regarding the comprehensiveness of CMS’ testing and training, the agency has several additional testing rounds scheduled through to the implementation date and multiple avenues of training planned for a wide variety of CE types—from small physician practices to hospitals to long-term care facilities.

Although the mood of the day remains optimistic, last week’s hearing was just that—a hearing. No definitive stance was taken, no rules made, no votes cast. Congress still needs to make a decision regarding the Sustainable Growth Rate (the bill that included last year’s implementation delay), and rumors of other threats continue to circulate.

ACDIS continues to support the October 2015 implementation date and encourages those vested in CDI to continue their own ICD-10-CM/PCS education and implementation efforts. The ACDIS website contains numerous resources to help you on your ICD-10 transition journey including case studies from CDI specialists, sample queries, implementation timelines, and member polls and surveys. If you need help with a particular concern please let us know.  

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