Benefits of the ICD-10 Transition

Thursday, 08 December 2011

The transition from ICD-9 codes to ICD-10 is long overdue. We have essentially run out of codes and unfortunately the timing could not be worse for physicians, hospitals and the healthcare industry overall. There is no good time to take this project on. It will be expensive, it will be tedious and it will not happen overnight.

In 1993 the World Health Organization (WHO) implemented the ICD-10 diagnostic code set to replace the ICD-9 code set, which was developed by WHO in the 1970s. ICD-10 is utilized in almost every country in the world except the United States. This code set is not simply an increased and renumbered ICD-9 code set, it comprises greater detail, changes in terminology, expanded concepts for injuries, and other related factors. The complexity of ICD-10 provides many benefits because of the increased level of detail conveyed in the codes.

When the dust settles, the benefits from implementing the ICD-10 code set will be noted. We can expect a decrease in claims returned for “insufficient documentation.” Historically, approximately 20% of all claims are returned to the provider due to lack of documentation to support the diagnosis or procedure code. The increase in granularity the ICD-10 codes provide should contribute to a decrease in administrative costs that are currently incurred using the ICD-9 code set. There should be an increase in auto-adjudication processes and a decrease in the need for the constant manual review, which currently delays reimbursement at a minimum of 60 days.

The new code set will clearly provide a better identification tool for patient population, demographics, and the tracking of disease in greater detail. Improved tracking of disease will improve case management and enhance the opportunity to involve patients in wellness programs. The global sharing of best practice information will also improve patient care and decrease morbidity and mortality rates in addition to contributing to more research globally. It will allow healthcare costs to be analyzed, outcomes to be measured in greater detail and finally processes and performance from the caregiver to be measured.

Bottom line - Meaningful Use, accountable care and the patient centered medical home processes are changing the industry from pay for performance to a payment for quality of care model. The detailed coding system the ICD-10 code set offers will support this move to improve our country’s quality of care. Without ICD-10 the multitude of changes impacting our healthcare industry will be ineffective.

Category: Healthy Practices