ICD-10: “What to leave in, what to leave out”
This lyric from Bob Seger’s song Against the Wind sums up a basic dilemma debated at the February 11th U. S. House Energy and Commerce Committee hearing on the implementation of ICD-10. On the one hand, it was argued that the additional clinical detail in ICD-10 would be an overwhelming documentation burden that would put some small physician offices out of business. On the other hand, physician specialty societies have been unrelenting in requesting that even more detail be added to ICD-10. Indeed, over the past three years there have been requests for 1,402 new ICD-10 codes from the major physician specialty societies. Although ICD-10 substantially increases the level of specificity compared to ICD-9, the medical societies are saying that this increased level of specificity is not enough and even more specificity is needed to keep pace with medical knowledge and innovation.
While the structure of ICD-10 can easily accommodate the new codes requested by the physician specialty societies, the additional detail may to some extent increase the documentation burden on physicians. The medical community is clearly conflicted over the level of specificity that is needed. At the February 11th hearing, the outspoken advocate of not moving to or delaying ICD-10 was a urologist. It is somewhat ironic that the American Urological Association has been one of the more aggressive medical specialties in calling for additional ICD-10 diagnosis codes with requests for 199 new urology diagnosis codes over the past three years.
Much of the demand for increased code specificity is driven by mandates from Congress related to payment reforms such as value based purchasing and other programs that link quality to payment. Coded data is the foundation upon which these programs are built. Without the increased specificity in ICD-10 these programs cannot accurately identify quality issues or adequately risk adjust for the patient populations being served. With the reputations and financial viability of providers at stake, relying on inadequate information is no longer an option. We may all long for simpler times, but with the advances in medicine and the policy mandates of Congress, simpler times are a thing of the past.
“Deadlines and commitments
What to leave in, what to leave out”
Lyrics from Against the Wind
With ever more deadlines and commitments, priorities have to be set and choices made. One thing is clear: the stakes are too high to fail to have the data needed to carryout the policy mandates of Congress. The stakes are too high to risk reputations and financial viability on inadequate data.
Should the request from the American Urological Association for 199 new ICD-10 codes be denied? If this is the level of specificity the Association’s leadership says is necessary, then clearly it should be added. However, the resulting documentation burden on small physician offices may be a legitimate issue. Fortunately, the market has responded to the challenge. As one small physician office testified at the hearing, the marginal cost of switching from ICD-9 to ICD-10 was virtually zero. The office’s EHR vendor simply turned on the ICD-10 version of its software and the office was up and running on ICD-10. The ICD-10 upgrade was free and the required additional documentation specificity proved to have little impact on the operations of the office.
The minimal additional documentation burden observed by this office is not surprising. Much of the increase in the number of ICD-10 codes is due to very simple distinctions like specification right or left. In obstetrics, for example, the number of ICD-9 codes is 1,104 versus 2,155 in ICD-10. The entire increase is due to the ICD-10 requirement to specify the trimester of the pregnancy. Without the trimester requirement there would only be 1,050 ICD-10 obstetric codes, which is slightly less than in ICD-9. Trimester is a critical piece of information, is readily available and does not present a documentation and coding burden.
While the physician office that testified at the hearing may represent a best-case example of the ease of the transition to ICD-10, recent surveys examining the cost of the ICD-10 for small physician offices have found that conversion costs are quite modest. As noted at the hearing there is even a free ICD-10 app for the iPhone that makes ICD-10 code lookup fast and easy. Furthermore, the members of the Coalition for ICD-10 stand ready to assist small physician offices to ensure a successful transition to ICD-10 in October 2015.
ICD-10: We need it. We’re ready.