Physicians Struggling with Consistency in ICD-10 Transition
By - ICD-10 implementation involves a complicated code conversion that physicians struggle to comprehend, and the mandated code change raises substantial financial concerns.
RevCycleIntelligence.com spoke with Andrew Boyd, Assistant Professor of Biomedical and Health Information Sciences at the University of Illinois (UIC) at Chicago, Physician, and Lead Author of a February Journal of the American Medical Informatics Association (JAMIA) study analyzing the intricately complicated terminological conversion of ICD-10 diagnosis codes.
Boyd and other UIC researchers created a web portal tool and translation table to facilitate transitions and cross referencing. Additionally, Boyd’s earlier JAMIA study examines the impact of patient safety reporting in hospitals demonstrated how patient safety reporting could also be compromised with ICD-10.
Keen awareness of how ICD-10 implementation is executed is necessary for both established and novice coders, says Boyd. The healthcare industry will need to demonstrate consistent mastery of the system’s complexities to ensure future success.
“When you consider value-based and population based care, you’re running reports off of ICD-9 codes for your increased or decreased reimbursement,” says Boyd. Coding styles need to be evaluated for consistency, he confirms.
If someone switches companies and brings new ICD-10 codes, variation or possible ambiguity in coding styles might mean an increase or decrease in reimbursements due to implementation of a variety of inconsistent codes, Boyd states.
“The majority of the ICD-9 CM to ICD-10 CM translations are complex and nonreciprocal, creating convoluted representations and meanings,” the study explains, also stressing coding consistency.
ICD-10 means the existence of five times more diagnosis codes, Boyd explains, affirming it is humanly impossible to know every single ICD-10 code with a challenge that is beyond human comprehension.
“The ultimate goal is to increase consistency and increase fidelity of diagnosis,” says Boyd. “However, when you have so many terms and so many rules, you have somewhere between 68,000 and 80,000 codes to choose from for every single diagnosis.”
Boyd’s research confirms variables were not always clearly and uniformly defined but need to be formerly distinguished in the immediate future.
As Boyd discussed the history of computer programming, a problem arose. “You could be counting deposits and banks but call your variables apples and oranges which means nothing to someone else,” Boyd says.
Boyd hopes that with this increased fidelity and high code volume, education will decrease variability with the number of codes and rules.
“You’re going to have variability. As that variability impacts the diagnosis code, it will impact reimbursement in the sense that a diagnosis code determines whether or not hospitalization is medically necessary,” says Boyd.
As the variability increases, it could have definite financial impact, maintains Boyd.
Boyd confirms based on prior experience in other fields, this proved to be a substantial concern, especially with there being such a high number of codes.
Since one code may become 400 codes under ICD-10, a tangible impact on revenue is to be expected. Helping healthcare providers make smart, researched decisions is key, says Boyd.
“When a clinician sees my three diagnosis codes map to five in a complex manner, they say, ‘I can’t run the report the same way. I have to make a new report.’” explains Boyd. “We want to make informed and intelligent decisions.”
Boyd says we should focus on examining previous examples of value-based care and population health.
“We need to realize what diagnosis codes are and what they’re not,” Boyd states. “One of the concerns I have with value-based care tied to ICD-10 codes is based on prior experience with Switzerland. It took them five years in a nationwide basis to get to the same accuracy with their version of ICD-10 then they did with ICD-9.”
A learning curve is needed for a smoothly executed transition, says Boyd.
“In five years will we love the data? Yes,” Boyd maintains. “Prior countries have shown there is a learning curve with ICD-10. We can train, educate, and dual code, but there’s a learning curve with three trillion dollars. That’s an expensive learning curve.”
Boyd says the industry can effectively keep up after implementation goes into effect.
“Everyone in healthcare is smart. At the end of the day, can we do this? Yes.”
Boyd thinks ICD-10 in the long term will be positive but the transition difficult.
“We have solved this. We would like to help other physician groups,” says Boyd. “We all want to do right by the patients and we all want to succeed.”
