ICD-10: Moving the Healthcare Industry Forward

Most healthcare professionals’ blood pressure likely rose a little on October 1, 2015 with the launch of ICD-10. Bruce Japsen’s article in Forbes articulates much of the apprehension about the transition from ICD-9 to ICD-10. The concerns are significant: many physicians and practices aren’t adequately prepared, coding and billing errors are inevitable as the new codes are adopted and initial delays in authorizations and payments are likely.

The implementation is a massive undertaking for providers, system administrations, insurers and employers — and patients will absorb some of the effects as well. But in spite of its many hurdles, ICD-10 is a much-needed transition for the growth of the industry and for improved patient care. It’s also an important shift as healthcare moves away from a fee-for-service payment structure toward fee-for-value.

You’re speaking my language

Coding is the only standardized language shared between providers to communicate patient information. And without precise language, we can’t give a clear picture of a patient’s health. It’s fair to say ICD-9 conveyed fairly limited information. It might have been adequate 30 years ago, but as healthcare and technology have evolved, we need a greater level of detail for proper intervention and care coordination. ICD-10 provides the precision to describe a patient to any provider involved in his or her care.

The terminology and documentation process between ICD-9 and ICD-10 is similar, but the main difference is that there’s far more information captured by the codes of ICD-10. These new codes include the severity, risks and complications of a patient’s condition — data that has a significant impact on the way conditions are treated.

Documentation is becoming a significant element of care quality and helps facilitate the interoperability we need. Because healthcare crosses boundaries of time and providers, detailed, up-to-date patient records are critical. People travel and need care outside of normal weekday hours, and sometimes many providers are involved in the care of the same patient. A lack of specific information and clear communication poses real issues.

Better information leads to better care

One of the primary weaknesses of ICD-9 was that there was no way to differentiate between levels of severity for a particular condition. To give you an example of how this could impact the level of care, consider a patient with asthma. In the past, if a patient went to the ER suffering from an asthma attack, the only information reflected in his or her medical record would be the ICD-9 code for asthma.

Now that could be mild, intermittent asthma, which means the patient would only need a short treatment in the ER before being sent home, or it could be severe, persistent asthma, which means the patient could die from an episode if not properly treated. But according to the code in the patient’s record, the asthma would look the same, regardless of the severity. And without specific information about the patient, an ER physician could easily make a decision based off the limited details in the chart, and the prematurely discharged patient could die a few hours later.

And under the ICD-9 codes there was virtually no way to compare treatment plans for different levels of the same disease. If one treatment could be successful for a mild condition but a different option was needed for a more severe condition, the information reflected by the codes didn’t give a good indication which treatment to pursue for a severe case.

Now that severity is standardized, treatment effectiveness can be more correctly assessed. As Japsen points out in his article, ICD-10 will lead to better chronic disease management through better communication and evaluation. And all of this will result in better outcomes for our patients.

ICD-10 and the medical home

In the bigger picture, this is where technology meets the medical home. Now that we have the medical home model and electronic records, and because of the interoperability that’s coming between systems and providers, good patient care can’t happen without the EHR. And a patient being seen by his or her familiar physician, the PCP who provides care on a continual basis — in the context of a medical home — will lead to the most accurate medical information and documentation.

Change for good

ICD-10 won’t be an automatic or easy adoption — there will be a learning curve here. But for the most part, the number of codes physicians deal with on a regular basis will be limited by their specialty.

It’s a burden to change, and all change has costs and speed bumps along the way. But patients can’t get the care they need without accurate, comprehensive communication between providers.

ICD-10 is a consistent development toward industry goals like team-based care, interoperability and fee-for-value. And the bottom line is that ICD-10 is a real step forward for patient care, leading to better diagnoses, treatment and health outcomes.