ICD-10 essentials for busy physicians who would rather be doing something else

This is the first in what I hope will be a useful series on the subject of ICD-10. My goal in writing is to offer clear, concise information about ICD-10 to physicians and physician practice managers, so they can focus on the key differences between the code sets — differences that actually matter for coding and documentation.

I have no intention of trying to persuade you that you should get religion about the benefits of ICD-10. Why should you love ICD-10? Do you love ICD-9? It's just a classification system. It slots your patients into categories of disease and treatment that payers and data-crunchers use to try to bring order to the chaos that is the U.S. healthcare system. ICD-10 is not a data wonder drug. It does not instantly improve the day-to-day care of patients. How could it? Data doesn't work that way. But the idea is that over time better data can contribute to a better system for our data-driven society.

Basically, ICD-10 is a long overdue upgrade. ICD-9 is old as the hills and needs to be replaced. The ICD-9 classification contains notions of disease and treatment from the 1960s that don't do any of us any good — the antiquated content of ICD-9 means physicians have to spend time answering questions about clinical language that hasn't been used in a generation or more.

Initial focus will highlight some general differences between ICD-9 and ICD-10 — not the ones that make for good yellow journalism, like the number of ICD-10 codes for getting bitten by various animals, but differences in clinical  terminology that are interesting from the point of view of good coding and documentation. I will spend time only on diagnoses that are common enough among those who seek treatment that most physicians will want to know about them — diabetes, asthma and congestive heart failure, to name a few.

Subsequent pieces will focus on specific ICD-10 differences by physician specialty.  Again, I will discuss only the handful of differences that matter for the most commonly treated conditions. For example, if I'm writing for pulmonologists, you can expect me to discuss asthma, COPD and pneumonia rather than Legionnaire's disease or SARS.

And finally, if you are still reading: Why should you listen to me? Excellent question — and one I ask myself all the time. In this case, it is because I know some stuff that you might find useful. I have been neck-deep in ICD-10 development and ICD-9 to ICD-10 conversion projects since I came to work for 3M 11 years ago. Projects include the ICD-10 GEMs (General Equivalence Mappings, an all-purpose "code translation dictionary" between ICD-9 and ICD-10) under contract to CMS for the past six years; mappings between ICD-10-CM and ICD-10 (the "parent" version of ICD-10 developed by the World Health Organization) under contract to the CDC going on now; development and maintenance of the ICD-10-PCS under contract to CMS since 2003; conversion of MS-DRGs to ICD-10 under contract to CMS since 2007; development of various ICD-9 to ICD-10 code translation tools; and conversion of APR-DRGs. I bring all this up not because I think you should be impressed by it — it's my job and I get paid to do it — but because it means I have been immersed in ICD-10 long enough that I have a pretty good sense of what's important about it. My eyeballs have spent a lot of time scrutinizing the differences between classification systems, and I can tell the important differences from the insignificant ones. I would like to share these with you in the clearest, most efficient way I can, so you can get on with the business of taking care of your patients.

Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems. She is responsible for the development and maintenance of the ICD-10 Procedure Coding System since 2003 under contract to CMS, and for the development and maintenance of the ICD-10 General Equivalence Mappings (GEMs) and Reimbursement Mappings under contract to CMS and the CDC.  She leads the 3M test project to convert the MS-DRGs to ICD-10 for CMS, and is on the team to convert 3M APR-DRGs to ICD-10. Rhonda also writes for the 3M Health Information Systems blog.


Comments (1)

Ydreyna: I’m in total argeement. CMS dropped the ball back in late 2008, prior to the Final Rule mandating ICD-10-CM/PCS in 2013, by failing to publish empirical data from other early adopters of ICD-10 that indeed the transition would improve quality of care, patient safety and lead to improved outcomes. While we know that gaining early by-in from physicians is critical, we are now less than 650 days out from the go-live date with only anecdotal support for ICD-10. It didn’t take a crystal ball to know that there would be tremendous physician push-back as the go-live date loomed ever closer. Regardless of the AMA’s position and clout, I would not hold my breath in anticipation of a delay, or reprieve, in the transition to ICD-10. In the end, hospital providers must work that much harder to engage physicians and gain their support for the transition, all along hoping that ICD-10’s touted benefits will sway physicians to support the mandate. Angela CarmichaelAngela Carmichael, MBA, RHIA, CCS, CCS-P AHIMA Approved ICD-10-CM/PCS Trainer

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