Policy & Regulation News

Is It Too Soon to Gauge ICD-10’s Long-Term Coding Future?

"You have to take a first step somewhere. This is our first step."

By Jacqueline DiChiara

- Regarding the future of revenue cycle management and ICD-10 implementation, is it merely too soon to tell what the long-term future of coding, laterality challenges, and documentation snafus holds? If so, what exactly comes next other than an alleged end-of-year game of hurry up and wait?

ICD-10 codes EMR implementation

To help shed light on this idea, RevCycleIntelligence.com chatted with J. Peter Barrett, DPM, practice owner of Penn Ankle and Foot Care, located in Pennsylvania.

RevCycleIntelligence.com: What should the healthcare industry expect regarding coding laterality and the like in the future?

Barrett: That’s going to be the next nail-biter. For those who are a little bit lax using ICD-9 with more of a general code, they’ve now transitioned to a general code in ICD-10. That’s going to kind of slap them in the face.

They have to be more specific from the get-go and get comfortable with how ICD-10 works. I’m not certain if all the systems get you comfortable with that kind of thing, with laterality and injuries.

You almost have to force yourself to do that now. You can't just stick with a family of codes. Being more aware of how you document can only help how we hold our records. 

The ultimate goal is to identify trends and then to act on those trends. And ultimately provide a better quality of care at a lower cost.

The longer we go into this new coding system, the better data we’ll have. We’ll be able to make better decisions. The final goal is to give better care, but we just don’t have enough data at this point to recognize what needs to be done.

RevCycleIntelligence.com: Although it may be too soon to have tangible, actionable data in front of you to work with, have you considered the possibility of running your own reports? Or is that too arduous or limiting to effectively execute at this time?

Barrett: It would be nice to be able to run our own reports and see if there’s something we can pick up sooner on our own. Otherwise, we’ll have to wait for reports to come out from the higher-ups. And then that’s kind of left to their interpretation. It would be nice to do it from our perspective, but I don’t know if we’re ultimately going to have that ability to run reports like that to see trends.

A lot is dependent on the individual practitioner and how they select their codes. As you become more specific, it will affect the reports more dramatically. There’s also a higher potential of errors. The more specific you are, the more errors. 

You hope everyone’s on the same page when they choose their codes. I don’t know if a report could be run to identify that they were using codes inappropriately. It’ll be interesting. It will take time to run reports and see what pops up. Maybe it’ll be something abundantly obvious.

I’ve done some legal cases where you have an opportunity to see how others record their exams and history. They differ dramatically. If you’re relying on this information to make future decisions on revenue and reimbursement, that’s a little scary. You would think in an ideal world that would be perfect. But when you see the charts, consistency is not clear.

RevCycleIntelligence.com: How has your overall Electronic Medical Record (EMR) experience been post-ICD-10 transition? Are you concerned that EMR inconsistency beyond your four walls is increasing the likelihood of medical errors?

Barrett: I keep on touting the benefits of Cerner’s diagnosis assistant software. It will not allow you to go any further if you choose a code that’s not appropriate. 

Although there’s other software out there, you end up having to go out of your EMR, research it, and then bring that information back to EMR and hope they sync.

It would be nice to have software everyone uses that communicates with all EMRs. But it’s probably not realistic. There’s a lot of potential for error. The information you can get out of a situation is only as good as the information you put in. But you have to take a first step somewhere. This is our first step.