ICD-10 Spotlight: Continue Practice Preparation

The future depends on the specificity that ICD-10 offers.

By Annie Boynton, BS, CPC, CPC-H, CPC-P, CPC-I, RHIT, CCS, CCS-P, CPhT

As Coding Edge went to press, Department of Health & Human Services (HHS) Secretary Kathleen Sebelius had just announced a proposed one-year delay of the implementation of ICD-10 to Oct. 1, 2014 from Oct. 1, 2013. Since February, when Centers for Medicare & Medicaid Service (CMS) Acting Administrator Marilyn Tavenner said CMS would “re-examine” the implementation timeline, there has been a lot of industry chatter regarding ICD-10. Many have been asking, “Where do we go from here?” While others, knowing there are hundreds of millions of dollars at stake, are pushing forward with implementation. This is a smart move. ICD-10 is coming, and we need to be ready.

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What Should Practices Do About ICD-10?

At this point, there is only one viable option: Continue moving forward with implementation. Any practice that equates a “re-examination” with a “termination” is putting itself at significant risk. Physicians and practice administrators should carry on with ICD-10 implementation plans, keeping a watchful eye on the Oct. 1, 2013 mandate.

Much of the information regarding ICD-10 in the marketplace is full of doom and gloom, and often is based on inaccurate or anecdotal data. In fact, ICD-10 does offer physicians benefits.

Value-based Purchasing Relies on ICD-10’s Specificity

Value-based purchasing is one concept that is not often heard in the medical practice, but—as any doctor who has argued an unspecified or miscellaneous code will tell you—it is a concept essential to accurate reimbursement. Value-based purchasing enables more accuracy in payment, based on the specificity in the ICD-10 codes. For example, compare the following ICD-9-CM and ICD-10-CM fracture codes:

ICD-9-CM Fracture Codes:

813.5 Fracture of lower end of radius and ulna open

813.50 Fracture of lower end of forearm, unspecified

813.51 Open Colles’ fracture

813.52 Other open fractures of distal end of radius (alone)

813.53 Open fracture of distal end of ulna (alone)

813.54 Open fracture of lower end of radius with ulna

 

ICD-10-CM Fracture Codes:

S52.57 Other intraarticular fracture of lower end of radius

S52.571 Other intraarticular fracture of lower end of right radius

S52.571A Other intraarticular fracture of lower end of right radius, initial encounter for closed fracture

S52.571B Other intraarticular fracture of lower end of right radius, initial encounter for open fracture type I or II

S52.571C Other intraarticular fracture of lower end of right radius, initial encounter for open fracture type IIIA, IIIB, or IIIC

S52.571D Other intraarticular fracture of lower end of right radius, subsequent encounter for closed fracture with routine healing

S52.571E Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type I or II with routine healing

S52.571F Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

S52.571G Other intraarticular fracture of lower end of right radius, subsequent encounter for closed fracture with delayed healing

S52.571H Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type I or II with delayed healing

S52.571J Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

S52.571K Other intraarticular fracture of lower end of right radius, subsequent encounter for closed fracture with nonunion

S52.571M Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type I or II with nonunion

S52.571N Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

S52.571P Other intraarticular fracture of lower end of right radius, subsequent encounter for closed fracture with malunion

S52.571Q Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type I or II with malunion

S52.571R Other intraarticular fracture of lower end of right radius, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S52.571S Other intraarticular fracture of lower end of right radius, sequela

The comparison of the code descriptions easily demonstrates the increased specificity in the ICD-10-CM code, and also demonstrates the greater incremental value of the ICD-10-CM code. This specificity will be an important part of value-based purchasing incentive programs in the future, and will help to more accurately demonstrate outcomes of care. Value-based pricing can help payers create reimbursement systems that are more targeted, which can mean more accurate reimbursement in the long term.

Importance of External Cause vs. Condition Codes

ICD-10 specificity is often the focus of media attention. One prominent example was the September 2011 Wall Street Journal article, “Walked into a Lamppost? Hurt While Crocheting? Help Is on the Way.” The article’s focus was on ICD-10-CM external cause codes. There is a code for an injury while crocheting (Y93.D1 Activity, knitting and crocheting), for being struck by an orca (W56.22XA Struck by orca, initial encounter), for being bitten by a duck (W61.61XA Bitten by duck, initial encounter), and even for sustaining injury while milking an animal (Y93.K2 Activity, milking an animal). But consider how often the average medical practice reports external causes in ICD-9-CM. The answer is rarely, and that is not likely to change much in ICD-10-CM.

Although the external cause and place of occurrence codes make for entertaining reading, the focus of specificity must be brought to the condition codes. For example, ICD-9-CM contains one code for male breast cancer, while ICD-10-CM has 19 codes to provide greater anatomic detail and to enable monitoring that has been impossible with ICD-9-CM. From a data, quality monitoring, and outcomes perspective, specificity counts.

Procedure Code Benefits

ICD-10 offers similar advantages on the procedure code side. ICD-10-PCS offers specificity that will be vital in analyzing outcomes or care. For example, in ICD-9-CM, there is a single angioplasty code (39.50 Angioplasty of other non-coronary vessel(s)). In ICD-10-PCS, there are over 800 angioplasty codes, each one with the vessel, location, method of approach, and device included in the code description. This means physicians and facilities will be able to more accurately represent the work they are performing; and that means, in time, we’ll see more accuracy in payment and pricing structures and incentive programs, as well.

Every Bit Helps

ICD-10-CM also supports reductions in administrative costs. Don’t scoff: The specificity in ICD-10 offers up real potential for reductions in medical record requests and administrative costs associated with copying and mailing records or supporting documentation. With the highest percentage of gross domestic product (GDP) allotted to health care of any country on the planet, the United States would benefit from even small reductions in administrative costs.

Carry On

What’s the bottom line? Continue on the ICD-10 implementation path. Health care has always centered on change. Improving health care reimbursement and care delivery systems, while evolving scientifically and technologically, are not new concepts. If we truly seek better, more affordable health care, then quality improvement, documentation, and data analysis in the future will depend on the specificity that ICD-10 offers.

Let’s keep calm, and carry on.

 

Annie Boynton, BS, CPC, CPC-H, CPC-P, CPC-I, RHIT, CCS, CCS-P, CPhT, is the director of 5010/ICD-10 communication, adoption, and training for UnitedHealth Group. She also teaches at Mass Bay Community College and she is a developer and member of AAPC’s ICD-10 training team.

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