The feeling of dread that accompanied last October’s initial rollout of ICD-10 did not appear to be repeated with the addition of thousands of new codes this Oct. 1 or the end of a “grace period” on the use of unspecified codes.
Reasons given for this confidence include that the bulk of the new codes were physician-generated and most of those are in cardiology. Also, the grace period only applied to physicians — hospitals were already required to code to the highest level of specificity. And finally, last year’s implementation went much smoother than anticipated.
“It was relatively quiet compared with all the horror stories coming out before,” says Nelly Leon-Chisen, director of coding and classification for the American Hospital Association.
In fact, preparation for this year’s changes was reminiscent of the preparation for annual changes that took place with ICD-9, according to Leon-Chisen.
“Just like in the past, you look at what’s new and ask, ‘What does it mean for me? What do I need to understand?’” she says, adding that the implementation of ICD-10 has led to better coding in physician offices than what existed under ICD-9.
Unspecified codes will still be allowed and, somewhat ironically, have their own specific code: The codes that end with “.90” in a particular family of classifications. “Hodgkin lymphoma, unspecified, unspecified site,” for example, is C81.90. “Crohn’s disease, unspecified, without complication” is K50.90.
“There will always be unspecified codes,” says Renee Stamp, director of reimbursement for Atlanta-based iHealth. She adds that, nationally, around 31 percent of claims may have been unspecified, though for practices iHealth worked with, the number was closer to 15 percent.
Instead of being imposed on physicians from regulators, the new codes for 2017 were developed by specialty societies such as the American College of Cardiology and the American Congress of Obstetricians and Gynecologists, Stamp says.
“We always tell physicians it really is moving in the right direction,” Stamp says. “I’m hoping [ICD-10] will speed up the claims process.”
Documentation issues still slow the process down and there seem to be more struggles with procedure codes rather than diagnosis codes, according to Nena Scott, director of education at Trust Healthcare Consulting Services in Tupelo, Miss.
Coders need to do a better job of linking a diagnosis to a lab report and being more specific about the site of injury or problem area, Scott says. While coders may often be doing their jobs far away from where care is being delivered, Scott thinks the answer to these problems is to have more on-site collaboration between coders and clinicians.
“It’s very important that these two come together,” she says. “I’m still a strong believer that, sometimes, you have to be face to face with the doctor.”
Scott, Stamp and Leon-Chisen all say they believe that it’s just a matter of time before the more granular data provided by ICD-10 pay off.
“With more specific codes, you can figure out if a patient population is having particular outcomes because maybe they didn’t follow a recommended diet or take medication as instructed,” says Leon-Chisen who predicts that ICD-10 data will provide new knowledge as to why some patients require longer lengths of stay or have more frequent readmissions.