Physician Practice

ICD-10 experts push back on physician concerns

Physician Practice Insider, August 11, 2015

In a recent interview, Sue Bowman, AHIMA senior director of coding policy and compliance, and Rhonda Buckholtz, AAPC vice president of ICD-10 training and education, answered questions about ICD-10 concerns expressed by W. Jeff Terry, MD, an American Medical Association (AMA) delegate from Mobile, Alabama. Bowman and Terry testified at February's ICD-10 hearing before the House Energy and Commerce Subcommittee on Health.
Bowman and Buckholtz responded to Terry's claims and offered advice for how to prepare physicians for ICD-10-CM. You can find an interview with Terry here.
Q: How do you respond to physician concerns about having to document differently than they're used to in order to accommodate ICD-10 language? What should they focus on in order to best prepare for implementation?
Bowman: Physicians may need to document more specifically to make the best use of the added detail in ICD-10-CM, but not necessarily "differently." ICD-10-CM actually reflects updated terminology that is more in line with clinician terminology than ICD-9-CM.
For example, ICD-9-CM refers to "intrinsic" and "extrinsic" asthma, which is outdated terminology and thus not typically documented by most physicians. ICD-10-CM classifies asthma as intermittent and persistent, which is more in line with how clinicians currently document asthma.
ICD-10-CM does include greater specificity in some areas than ICD-9-CM, but this increased specificity has to do with aspects such as laterality, anatomic site, and disease severity. Fully 46% of the increased detail in ICD-10-CM is due to the addition of laterality (left or right side). Laterality does not seem like a new "ICD-10 language" and should be reflected in good clinical documentation.
Physicians should focus on providing complete and accurate clinical documentation—being as specific as possible regarding the disease type, site, severity, and laterality. The more complete and accurate the documentation is, the more complete and accurate the coding will be.
Buckholtz: Many of the concepts found in ICD-10-CM should already be captured in current documentation. They should already be familiar with common clinical indicators, such as type, anatomical location, temporal factors, and complications/manifestations.
Q: Some physicians do not believe ICD-10-CM will have any impact on patient care. What are the advantages to moving to ICD-10-CM for patients that HIM or coding managers can share with physicians?
Bowman: Improvements in patient care depend on good data, and ICD-10-CM providers much better data than ICD-9-CM. Better data for analysis and research will lead to improvements in patient outcomes and patient safety. More detail about patients' clinical conditions means an improved ability to manage chronic diseases by better capturing patient populations as well as an improved ability to identify high-risk patients who require more intensive resources, assess effectiveness and safety of new medical technology, and manage population health.
Access to better data will lead to increased patient engagement (due to better data to guide consumers' choices regarding their care). Better data will also provide better justification of the medical necessity of services provided, thereby leading to fewer denials and appeals based on medical necessity.
Buckholtz: ICD-10-CM should not have an impact on patient care. It should enhance the ability to offer services and procedures through accurate submission and documentation.
Q: How do you respond to physicians who think that waiting for ICD-11 is the best course of action?
Bowman: ICD-11 will not be released before 2017. For the U.S., that date is the beginning, not the end, of the process toward adoption of ICD-11. The process of evaluating ICD-11 for use in the U.S., developing a national modification to meet U.S. information needs, and developing a procedure coding system would take at least a decade, followed by the rulemaking process to adopt ICD-11 as a HIPAA code set standard.
Replacement of ICD-9-CM is already long overdue. Waiting until ICD-11 is ready for implementation in the U.S. is not a viable option, as waiting that long to replace the ICD-9-CM code set would seriously jeopardize the country's ability to evaluate quality and control healthcare costs. U.S. healthcare data is being allowed to deteriorate while the demand increases for high-quality data that can support new healthcare initiatives.
Also, implementing ICD-10-CM/PCS is an important step on the pathway to ICD-11.
Buckholtz: ICD-11 is still in beta format and has not been finalized. We only have speculation. In addition, it is highly dependent on technology, which many physicians still do not have.

Read the full article by Steven Andrews on
HealthLeaders Media.

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