Manage and Share Data Across Countries

Take a logical approach to ICD-10 and see the international benefits.

By Rhonda Buckholtz, CPC, CPMA, CPC-I
You’ve probably heard stories about other countries’ ICD-10 implementation woes. Studies indicate it took a year or more for productivity to rebound in other countries following ICD-10 adoption—and most of those countries only implemented 20,000 or fewer new codes. In the United States, we are looking at implementing close to 70,000 ICD-10-CM codes.
My advice: Don’t panic! Taking a logical approach to “code volume” will put the United States in line with other countries. And if we learn the facts and plan well, we may even avoid extended productivity losses.

Grouping Codes Logically Makes ICD-10 Manageable

Although we have more clinical modifications than other countries, ICD-10 isn’t as overwhelming as it appears. For example, there is one code for a malunion in ICD-9; whereas in ICD-10, there is a seventh character extender that explains a malunion, attached to most fracture codes. The number of codes may be greater, but the organization of those codes is fairly intuitive.
Here’s another “volume buster” to consider: For conditions that can affect either side of the body, there are laterality choices in ICD-10. That means there are usually four code choices: One for the left side, one for the right side, a bilateral, and an unspecified. One condition equals four codes. By “grouping” conditions this way, we reduce these codes to a more manageable number.
Here’s another tip: Ignore subcategories of codes with an “unspecified” choice. Seriously work towards not having to use them. Some of the guidelines specifically state not to use them.

Documentation, Not Code Volume, Matters Most

Rather than the number of codes, what should concern us about ICD-10 is the specificity of those codes. The devil is in the details; and as coders, we need to update our knowledge of disease processes and anatomy, as well as improve our relationships with clinicians. We need to work with those who document the medical record, so all of the elements necessary in coding are captured.
For example, when coding hyperlipidemia, why do we so often choose “unspecified?” The patient has been treated for years, we have blood work, but we fail to change the code once the type has been determined. This requires communication with the provider to let him or her know that when the type has been determined, that information should be documented (and coded).
For coronary heart disease, documentation will need to include the type of graft and if the patient is also experiencing angina pectoris. This specificity will be necessary to apply ICD-10 codes.
Here’s a third, more complex, example that demonstrates why we need to improve our knowledge and communication with providers: The subcategory of F31.7 Bipolar disorder currently in remission includes choices for “full remission” and “partial remission,” and caveats for the most recent episode (e.g., manic, depressed, hypomanic, or mixed). Do you understand the differences between these codes and how they should be applied? Will your providers’ documentation stand up to the specificity? Teamwork will be necessary for success.

Speak the International Language: ICD-10

The true value of ICD-10 comes from the ability to share data in a meaningful way—not only within the United States, but also with other countries. Every country is responsible for making its own clinical modifications to ICD-10, but the core meaning of each code is the same in any language, allowing us to cross borders.
For example, C92.2 may be defined as Posostra bialaczka szpikowa, or Υποξεία μυελογενής λευχαιμία, or Ohne Angabe einer kompletten remission, or Leucémie myéloïde subaiguë, or Leucemia mieloide sua-acuto. Translation: Atypical chronic myeloid leukemia, BCR/ABL-negative.
Before we can realize the benefits of an “international language” and achieve full use of the code sets, we need to speak the same language within our own practices. There will be many challenges along the way, some of which may be due to our Z73.1 Personen, die das Gesundheitswesen aus sonstigen Gründen in Anspruch nehmen, or Άγχος, στρες, που δεν ταξινομείται αλλού, or Stres niesklasyfikowany gdzie indziej, or Accentuation de certains traits de la personnalité (Type A behavior pattern). Or, the problem might arise due to Z56.3 Personen mit potentiellen Gesundheitsrisiken aufgrund sozioökonomischer oder psychosozialer Umstände, or Rythme de travail pénible, or Στρεσσογόνο εργασιακό πρόγραμμα, or Stresowe warunki pracy (Stressful work schedule).
Whatever the challenge might be, it’s time for us to face it head on. Let’s move past meaningless statistics and face reality. The new coding system is coming, it’s long past due, and we need it. Our coders are the best in the business and we are up to this challenge. We can bring our physicians and others onboard with us for this journey.
Use the next few months to strengthen your skills, test your limits, and begin working with your teams. Open the lines of communication with your physicians to improve their documentation and begin the transition to ICD-10. Don’t try to do it all overnight, but instead work in stages. Start with the conditions your providers see most in their daily practice.
We can make a difference, one code at a time.
Rhonda Buckholtz, CPC, CPMA, CPC-I, is vice president of ICD-10 training and education at AAPC.

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