August 20, 2017

Practice Management – ICD-10 is Coming to Town. Start Getting Ready Now.

By Bassam A. Kawwass, FACHE

PracticeManagementpict“We agree with your recommendation to continue progress towards ICD-10 implementation and maintain our commitment to the October 1, 2014 compliance date. Based on your feedback and other stakeholder input, the Centers for Medicare & Medicaid Services (CMS) believes that the one-year extension offers physicians adequate time to train their coders, complete system changeovers, and conduct testing. Furthermore, we have found that many private and public sector health plans, hospitals and hospital systems, and large physician practices are far along in ICD-10 implementation. CMS has taken action to reinforce this message to the industry and have responded to the American Medical Association.

Likewise, we believe that ICD-10 is foundational for healthcare reform and a cornerstone of several integrated programs that build toward a modernized health care system and work in concert to achieve better care, better health, and lower costs. Integrated programs such as Version 5010, the ICD-10 code itself, the Medicare & Medicaid Electronic Health Record Incentive Programs, and the physician quality reporting system are all aimed at accomplishing these outcomes. Together, they move America’s healthcare system towards better coordinated care through greater interoperability and ease of transmitting electronic data; better quality measurement and reporting of clinical outcomes data; and lower costs achieved through operational efficiencies.”

CMS Office of E-Health Standards and Services, February 13, 2013

It certainly is an exciting time of healthcare reform for the United States. Some of that excitement (or anxiety) revolves around the transition from ICD-9 to ICD-10, which is the classification system currently being used by the majority of the world. The US is the only industrialized nation not using an ICD-10-based classification system.

ICD-10-CM is a clinical modification of the World Health Organization’s ICD-10, which consist of a diagnostics classification system. With 68,000 diagnoses codes, ICD-10-CM includes the level of detail needed for morbidity classification and diagnostics specificity in the United States. It also provides code titles and language that complement accepted clinical practice in the US. ICD-10-PCS (87,000 procedure codes) was developed to capture procedure codes. This procedure coding system is much more detailed and specific than the short volume of procedure code included in ICD-9-CM.

Two main reasons have been stated for the necessity of the transition to ICD-10-CM/PCS:

1. Payors cannot pay claims fairly using ICD-9-CM since the classification system does not accurately reflect current technology and medical treatment. Significantly different procedures are assigned to a single ICD-9-CM procedure code. Limitations in the coding system translate directly into limitations in the diagnosis-related groups (DRG).

2. The healthcare industry cannot accurately measure quality of care using ICD-9-CM. It is difficult to evaluate the outcome of new procedures and emerging health care conditions when there are not precise codes. Most importantly, we have a mission to improve our ability to measure health care services provided to our patients, enhance clinical decision-making, track public health issues, conduct medical research, identify fraud and abuse and design our payment systems to ensure services are appropriately paid.

A lot of education and preparation on the structure, benefits and changes will be required if we want to achieve a smooth transition by October 2014.

Bassam A. Kawwass, FACHE is the administrator for Cardiovascular Associates, Ltd. (www.cval.org), the premier largest independent, full-service cardiology practice E-mail: bkawwass@cval.org. Mr. Kawwass served as past Regent at Large for the American College of Healthcare Executives. He earned a Master’s in Health and Hospital Administration from Virginia Commonwealth University, a Medical Records Administration degree from St. Louis University, and a Bachelor’s in Business Administration from the American University of Beirut, Lebanon.