Benefits of Implementation
By Rhonda Buckholtz, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC
Even though at this point it is hard to see down the road, there are many anticipated benefits of ICD-10-CM. One of the major benefits in moving to ICD-10-CM is that providers will have the ability to better describe new diseases and new understanding of diseases such as diabetes, HIV, injuries and external causes, drugs and neoplasms. ICD-10 will allow expertise in clinical classification and terminology that will assist in the use of clinical terminologies in electronic health records as well as provide international compatibility. ICD-9-CM is over thirty years old; it is outdated and there is no room for future expansion.
Although an improvement in the clinical categorization of diagnoses is beneficial, the real benefit is greater—more specificity of the codes, which permits more patient information to be recorded. Coding error rates are the difference between the reported code and the actual (correct) code for one or more diagnoses. The more accurate clinical terms in ICD-10-CM and the more specific code descriptions indicate that error rates will eventually be reduced significantly. When this will happen is hard to predict, especially with initial learning curves and productivity issues.
The cost of reducing coding errors is difficult to quantify without knowing the consequences of these errors. If errors that are not caught result in erroneous payments (false claims), repercussions could include repayment, returned claims, carrier fraud investigations, etc. One of the potential benefits from switching from ICD-9-CM to ICD-10-CM is that fewer claims would be sent back for more information, and one in five claims would be paid without additional documentation or questions asked. Keep in mind ICD-9-CM codes were not developed for reimbursement purposes. ICD-10-CM, however, offers more rationale upon which to build support for medically necessary procedures and services. This will also depend upon payers revamping all policies related to payment off of diagnostic codes.
Greater specificity regarding clinical conditions and services delivered will provide payers, policy makers and providers with better information to make major refinements to reimbursement systems, including the design and implementation of pay-for-performance programs.
There will be true benefits to the implementation of ICD-10; keep your goals in sight and work towards successful implementation.