ICD-10, arguably one of the most far-reaching and complex regulatory mandates for health care providers and payers alike, was originally scheduled to take effect on Oct. 1, 2013. Well, maybe “originally” isn’t the best word since the compliance date has changed several times. The most recent proposal has pushed the deadline back to Oct. 1, 2014.
But those changes, says Wendy Whittington, MD, MMM, chief medical officer at Anthelio, an independent provider of information technology and business process services, are quite troublesome.
“How can you do good planning and deciding how you’re going to train people if [deadline dates] are going to change?” Whittington asks, rhetorically. “I equate this to bad parenting. If you tell your kids that they absolutely have to do something by a deadline, and you keep changing the deadline, they’re never going to clean their room.”
If physicians develop that mindset with the often-delayed ICD-10 deadline, it could be problematic, says Whittington.
No sigh of relief
Whittington explains that many physicians see ICD-10, which increases the 13,500 diagnostic codes under ICD-9 five times to nearly 70,000 codes, as a nuisance. They see it as one more government mandate that requires them to invest more of their own money. As such, it’s not surprising that many heaved a huge sigh of relief at the proposed postponement until 2014.
“But one of my biggest worries is that they heaved a sigh of relief and thought, ‘Oh good, I’m never going to have to deal with that,’” says Whittington, though she agrees that there are pros and cons to the delay.
On the provider side, it not only affords more time to meet compliance requirements, but to do it right. Whittington says that with all the other changes providers were implementing — such as installing EMRs and meeting meaningful use requirements — many providers were going to do the bare minimum to get through the Oct. 1, 2013 deadline.
“But if we in health care take the attitude that we’ll just wait until things settle down and then we’ll do some of these important things, we’re going to be waiting a really long time,” Whittington says.
Not so daunting
By increasing the number of diagnostic codes five-fold, ICD-10 sounds like it could have a major impact on a medical practice’s workflow. But Whittington suggests that the changes are not quite as daunting as they sound. She says that as a physician, she doesn’t have to memorize every single ICD-9 code that she uses. Instead, she uses certain phrases in her documentation, or she clicks on certain diagnoses from a list in her electronic health record.
“I’m not thinking to myself that otitis media is a 382.02,” Whittington says. “I don’t have to do that numbers game. I just have to get the right phrase so that my coder can assign it an accurate code.”
With the switch to ICD-10, says Whittington, documentation is going to need to be more specific and accurate in order to attach the proper code, but physicians will still not need to memorize all those codes. For example, now Whittington says the diagnosis is otitis media, and there’s a matching ICD-9 code. But with ICD-10, the specificity increases, so she might have to say left, acute otitis media, first onset.
“That’s the hard part,” Whittington says. “It’s not that I have to memorize the codes. It’s that I have to make sure the specific information is used.”
And in preparation for the transition to ICD-10, Whittington suggests physicians start developing that specificity mindset.
“We have nothing to lose now by being more specific and complete in our documentation,” she says.
Be tech savvy
With concerns about meeting the ICD-10 deadline running high, many providers have indicated they plan to purchase an inpatient computer-assisted coding solution in the coming two years. Whittington says she’s a fan of the computer-assisted coding concept, and believes it will make physicians’ lives easier. But she doesn’t think it’s the solution to the immediate transition challenge.
“First of all, it’s really in its infancy in the hospital environment, and it’s not something most basic primary care office sites are investing in,” she says. “It’s a neat thing, it has great promise, and I’m convinced that it’s going to help. But don’t put too many eggs in that basket just yet.”
And as medical practices install electronic health records and other new technologies, Whittington suggests they consider the following questions: What’s going to happen with the ICD-10 switch and this particular software? How is it going to fit?
“Physicians should be looking at all of their different projects not in silos, but in kind of a holistic approach to where is this all going to fit in the new ICD-10 world,” Whittington says.