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The looming transition from ICD-9 to ICD-10 in October 2014 goes hand in hand with the goal of healthcare reform, which is intended to improve quality and decrease the cost of care.

With more than 171,000 codes (compared to just 17,849 in ICD-9), ICD-10 will provide a much more accurate method of quantifying levels of care. The transition will have a far-reaching impact on all populations of healthcare organizations, including physicians. In fact, ICD-10 will affect every aspect of the physician’s practice, including patient encounters, clinical and financial workflow, and, depending on the circumstances, compensation, reimbursement and future career opportunities. All physician groups will be affected by ICD-10 as well, including surgeons, hospitalists and physicians in ambulatory settings.

Though the transition to ICD-10 poses challenges, it also promises benefits to physicians in particular, including more appropriate reimbursement, improved outcome indicators, reduced potential compliance issues and fewer claim denials. But these benefits only can be achieved if physicians take the time to prepare themselves properly by engaging in comprehensive ICD-10 training and preparation.

How Can Physicians, Their Practices and Their Patients Benefit from ICD-10?

Time is a precious commodity to physicians, and many, understandably, do not relish the prospect of spending their already limited time on training and education. It is clear, however, that physicians who take decisive steps to integrate ICD-10 codes into their clinical practice stand to benefit in several ways. It can help them:

  • Determine severity of illness and prove medical necessity consistently. ICD-10 codes better describe the gravity of a patient’s illness, in turn facilitating validation of conditions in support of utilization of goods, services and complex procedures.
  • Grow compensation and reimbursement. ICD-10 codes help physicians create an electronic trail of evidence, allowing them to receive proper credit and payment from government payors, insurers, hospitals, health systems, medical groups and others.
  • Address technology and healthcare reform initiatives. These include the value-based purchasing system managed by the Centers for Medicare & Medicaid Services (CMS), pay-for-performance programs (P4P), coordinated care models such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs); the government’s Physician Quality Reporting System (PQRS); and the move toward adoption of an electronic health record (EHR).
  • Ensure a strong reputation. A physician’s documentation trail in ICD-10 will inform:
    • Physician profiling/national registries
    • Quality reporting
    • Consumer health sites
  • Reduce the hassle of audits. ICD-10 codes allow physician documentation to be translated into a more accurate clinical picture, thereby reducing the chance of misinterpretation by third parties, auditors and attorneys. Understanding ICD-10 and implementing documentation integrity safeguards will help save time and resources during a Recovery Audit Contractor (RAC) audit, or, even better, prevent the audit from occurring in the first place. Insufficient documentation, on the other hand, may lead to scrutiny and potentially takebacks by CMS.
  • Improve care. ICD-10 codes will generate more detailed healthcare data and an improved flow of that data to improve medical communication, which could contribute to the development of more advanced disease protocols and clinical pathways.

In order to achieve these important potential benefits, it is critical that all members of a physician’s team receive the appropriate education for their job functions – and that the team works collaboratively to face ICD-10 head-on.

About the Author

Thomas Ormondroyd, BS, MBA, is vice president and general manager of Precyse Learning Solutions. He oversees several business lines, including Precyse University, ICD-10 Consulting and Education, and Clinical Documentation Improvement Services. Tom and his team are responsible for building Precyse University, a revolutionary online learning system and program built to deliver education to prepare healthcare professionals for the challenges of today and tomorrow.

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