ICD-10 Transition Likely Bumpy Into Early 2016

The U.S. health care system began using the International Classification of Diseases 10th edition on Oct. 1.

ICD-10 replaces the decades-old 9th edition, and it represents the largest change in coding since the revision of evaluation and management CPT codes in 1992.

“The change to ICD-10 allows you to capture more details about the health status of your patients and sets the stage for improved patient care and public health surveillance across our country,” Sean Cavanaugh, deputy administrator and director of the Center for Medicare at CMS, said in a blog post. “ICD-10 will help move the nation’s health care system to better, smarter care.”

William D. Rogers, MD, FACEP, ICD-10 ombudsman at CMS, said in a blog post that ICD-10 promises to help physicians and other health care providers better coordinate care, keep more detailed records and more accurately define patients’ clinical conditions, as well as implement new payment methods.

It will also allow for data comparisons between regions of the United States and the rest of the world, and may help improve clinical and surgical practice guidelines across the entire spectrum of health care services, Rogers said.

Kevin J. Corcoran — president of Corcoran Consulting Group, which has so far trained more than 6,100 physicians and staff in ICD-10 — told HemOnc Today that he expects the rollout likely will “be bumpy for the first few months, with slower payments and many unsatisfactory claims due to inaccurate ICD-10 codes.”

Illustrating the challenges associated with switching to ICD-10, Corcoran pointed to the last two countries to adopt it — Australia and New Zealand. He noted that about half of all medical records were too cryptic, brief or ambiguous to permit selection of an ICD-10 code. Physicians had to amend or replace their impression and/or diagnosis to allow billers to code it.

“ICD-10 requires more detail,” Corcoran said.

He recommends physicians incorporate laterality, etiology, manifestations, comorbidities and greater specificity in their notes. Without this detail, claims submission is arrested pending further information from the ophthalmologist.

For example, if a physician notes “glaucoma” in a chart, there isn’t enough information to select an ICD-10 code. What’s missing? The type of glaucoma (eg, open-angle or narrow-angle), the severity (eg, mild, moderate or severe), and which eye is affected.

“The biller cannot simply guess these things,” Corcoran said.

The transition to ICD-10 likely will take a few years, Corcoran said.

“CMS will not be very strict in the first year,” he said. “This is more complex than some people believe, and requires more detail than some people imagine, so there are a lot of ways to stub your toe.” – by Jason Laday

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Photo courtesy of: Medical Coding News

Originally Published On: Helio.com