4. How more accurate coding will affect patient care. 

Sisko:

It will ensure providers are doing what they should have been doing all along. According to Sisko, ICD-10 will increase first pass adjudication rates, resulting in faster claims payment and less administrative hassle for providers and patients. “Enhanced documentation of a patient’s clinical condition can only improve care and will enable a more accurate means of sharing information with other caregivers,” he said. “More specific diagnoses codes and more accurate definition of procedures performed will be the Lingua Franca for HIE’s.” More accurate coding will facilitate auditing efforts, reduce time related to RAC inquiries, and should decrease ability for fraudsters to game the system, he added. 

[See also: ICD-10 prep on the upswing, says AHIMA .]

“The other thing is bilaterally, left to right. So you have a broken leg and it’s the second time you’ve been to the doctor versus the first time. The second time the payment for that should have been bundled with the first. So, they’re taking these two elements, which are combinations of the single code, so of course it increases the code set, but providers should have been collecting this info all along. They’re grousing this is an extra burden. Well, it shouldn’t be.” ICD10 Watch participant, David Saintsing, added a broad clinical and informatics view and analysis, “would show that ICD-10, from a patient outcome perspective, would improve over time the standards of care for a particular illness, as we, as scientists, get a greater level of detail.”

Tennant:

We don’t know enough to implement ICD-10. “The quality of healthcare would not change at all,” said Tennant. “This is a change in code set.” Tennant referenced the Wall Street Journal article, which took a humorous look at all the irrelevant codes associated with ICD-10. “I think that was one of the catalysts for the vote by the AMA; it talked about being bit by a turtle or walking into a lamp post or being burned if your water skis were on fire. But should we be basing our reimbursement coding system around that? No.” He added one of the arguments is we don’t get to the granularity available to ICD-9. “There is something called unspecified, but virtually, in every category, there is the ability to code unspecified, or you can select a more detailed code.”

The question is, said Tennant, will physicians code to this more granular level? And if they don’t, then will we gain the advantage of moving to this new code set? “And if they do, what will be the payment policies of the health plans, including Medicare, for example. Maybe health plans require the most granular codes and other ones will accept unspecified. So the payment policy issue is one of those great unknowns, and health plans have not yet been announcing their payment policy. That is one of those issues that will have a tremendous impact on physician practices.”

Follow Michelle McNickle on Twitter, @Michelle_writes