ICD-10: How the New Code Set Can Help Your Practice Long-Term

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New Code Set Benefits Should be Significant

With providers scrambling to make final preparations for the looming ICD-10 code transition, most haven’t had a lot of time to focus on the long – term benefits the coding change will produce.
But ICD-10 proponents believe the changeover’s improvements will be dramatic and
ultimately lead to enhancements in the way providers are paid, how diseases are managed and the manner in which research and public health are pursued in the U.S.
“For months, the focus has been on making sure that the transition goes smoothly and
does not result in major productivity declines or cash flow disruptions,” said Cindy Slocum, the ICD-10 implementation project manager for McKesson Business Performance Services (McKesson). “Assuming those worst-case scenarios are avoided,
organizations should fairly quickly begin to see the benefits of the new system.”
As an example, Slocum said that the enhanced specificity in ICD-10 should decrease the number of pended claims for requests for medical records since the new code set will provide the information not included in ICD-9 codes today. Reducing administrative overhead costs associated with re-processing claims is a win that both payers and physicians will derive benefit from.

Stronger disease management

In the longer term, the new code’s granularity should also support higher reimbursement for new procedures, disease management programs, and other services that involve a range of complex or integrated steps and capabilities. Slocum said ICD-10 data will likely be central to developing equitable reimbursements schemes in an accountable care setting. Equally important, clinical improvements should also flow from the additional information.

Better disease management will be supported by ICD-10 through improvements in screening, prediction, disease identification, treatment and compliance. For example, ICD-10 provides multiple divisions for type 1 and type 2 diabetes mellitus, along with a dramatic increase in the number of sub-classifications to create a more flexible and responsive code.(1) The additional information can improve clinical management by allowing doctors to better select the most appropriate treatment for a specific patient (2), make earlier interventions, and more effectively track treatments and conditions.(3)

Similar refinements are expected to have an impact on the treatment of asthma, heart disease and other chronic illnesses.

Improved research data

In the area of public health and research, ICD-10 is expected to generate new insights by illuminating heretofore hidden patterns and relationships across disease, treatment and outcome spectrums.(4)  The data will also allow for more precise evaluation of new medical procedures, and eventually enable providers to measure their performance and outcomes against their peers.

Interestingly, ICD-10 will additionally create a better understanding of medication non-compliance, according to Marybeth Regan, PhD, a healthcare solutions expert with IBM Global Business Services. In a 2012 American Health Information Management Publication, Regan noted that ICD-10 will provide options to capture information on medication adherence, including reasons for non-compliance, such as a lack of financial resources.(5) This is an important development, given that up to 75% of adults are, or have been, medication non-adherent in one or more ways.(6)

Slocum said the many positives of ICD-10 will become more apparent once the long-awaited transition is complete.

“It’s true that most organizations are focused almost exclusively on the October 1 date right now and not looking further to consider how they may benefit from ICD-10,” Slocum said. “That’s understandable, given the complexity of the transition and the financial stakes involved. But despite the dread many are feeling, I am confident that we will survive the transition and that ICD-10 ultimately will prove to be a boon for healthcare. The only question is how soon we get there.”

(Article: Compliments of Mckesson)

(1) Marybeth Regan, “Is ICD-10 the Holy Grail for Disease Management?,” For the Record, American Health Information Management Association, May 7, 2012.
(2) Shelly K. Schwartz, “The Benefits of ICD-10 to Medical Practices,” Physicians Practice, Oct. 16, 2013.
(3) Marybeth Regan, “Is ICD-10 the Holy Grail for Disease Management?,” For the Record, American Health Information Management Association, May 7, 2012.
(4) Sue Bowman, “Why ICD-10 is Worth the Trouble,” American Health Information Management Association research library, (originally published in the Journal of AHIMA 79, no. 3, March 2008)
(5) Marybeth Regan, “Is ICD-10 the Holy Grail for Disease Management?,” For the Record, American Health Information Management Association, May 7, 2012.
(6) Ibid.

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