ICD-10 Delayed, Again … Now What?

Make the most of the reprieve to prepare for the inevitable.

By Melissa Weintraub, CPC

I watched the actions of Congress on March 27 and March 31 with bated breath. It came as no surprise that they put another “patch” over the festering Sustainable Growth Rate (SGR) formula to forestall a severe cut in Medicare payments to physicians. Whether the patch is the right thing to do is a completely different story. Incorporating a delay to ICD-10 in the H.R. 4302 bill, however, took me and most of my colleagues completely by surprise. We have all been counting down to October 1, 2014. At the HIMSS Conference in February, Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner announced that there would be no further delays of ICD-10. She said it would happen in no uncertain terms.

Why We Should Champion for ICD-10

I have heard many theories on whether ICD-10 will ever happen. My money says it will. It must happen for all of the reasons the United States sought to adopt it in the first place:

  • Additional data will be available for tracking public health.
  • ICD-9-CM is outdated and maximized.
  • With ICD-9-CM, we do not have the granularity of data that can help in public health planning and initiatives. Granted, I have heard many physicians complain that no one cares if the injury is on the left or the right; the granularity of the data is meaningless. Perhaps they are correct. There is a definite need for the laterality discussion down the road. For now, let’s talk about the benefits of ICD-10’s specificity.

For example, consider public health awareness of a new cluster of Group A Streptococcus bacteria (strep throat) that’s showing resistance to antibiotics. That information can be gleaned from ICD-10 diagnosis coding without the need to dig through charts, and provide clues to a potential outbreak.

In another example, imagine a cluster of women who are all developing pregnancy-induced hypertension in the same trimester, approximately the same week of pregnancy, and in the same geographical area. Without ICD-10’s specificity, this sort of thing could go unnoticed.

The research capabilities with ICD-10’s enhanced data are astronomical, and our ability to use that data to find the cause and effect for diseases is so incredibly important for public health. I find it mind-blowing that the brakes have been put on again.

Where Do We Go from Here?

ICD-10 has never really been a “coding” problem. The problem lies in documentation and electronic transmission.

Just because ICD-10 is delayed until at least October 1, 2015 doesn’t mean our quest for self-improvement and quality care should stop. Physicians should continue to improve documentation to ensure quality medical records. Coders should continue to look at records to assist physicians in knowing what additional information will need to be documented down the road to ensure proper payments. Payers should continue their efforts, as well, testing end-to-end electronic transmission to ensure claims safely move from point A to point B.

We have made great strides in preparing for ICD-10. If we continue to move forward, not only will we experience fewer growing pains when ICD-10 is finally released, but we will all be better for it.

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Melissa Weintraub, CPC, is coding compliance specialist with Nova Compliance Group in Troy, Mich. She has more than 20 years of healthcare experience in billing, coding, compliance, education, and software development. Weintraub is a former administrator for both a large health system and billing company in the Detroit area. A certified ICD-10 instructor, Weintraub teaches ICD-10-CM and ICD-10-PCS programs through the American Institute of Healthcare Compliance. Weintraub is preparing for her CPC-I credential, and she is a member of the Macomb Township, Mich., local chapter.

Michelle Dick
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Michelle Dick

Executive Editor at AAPC
Michelle A. Dick has been executive editor for AAPC for over seven years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. Dick has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.
Michelle Dick
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Michelle A. Dick has been executive editor for AAPC for over seven years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. Dick has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.

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