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Waiting for ICD-11 not the answer, it's time for ICD-10, consultant says

The Advisory Board revenue cycle head Ed Hock says punting on ICD-10 until the new code set is ready robs healthcare providers of the benefits.

Susan Morse, Senior Editor

Graphic by HIMSSGraphic by HIMSS

Not everyone is calling for the death of ICD-10 (in fact, few are). And according to The Advisory Board, the idea of waiting until ICD-11 as American Medical Association President Steve Stack suggested last week makes very little sense.

“To say go straight to ICD-11 is mostly saying we shouldn’t do anything for a long time,” said Ed Hock, director of revenue cycle solutions for the consulting firm. “A push to go to ICD-11 is really a push to not change at all for at least another five to seven years, and most likely longer than that.”

If moving from the 14,000 codes under ICD-9 to 68,000 codes under ICD-10 is tough, it will be harder to move from ICD-9 to ICD-11, Hock said.

[Also: AMA chief says US should wait for ICD-11]

“These code sets will have continued to advance,” said Hock, who added that  it’s too early to tell how many codes will be in ICD-11.

Plenty of providers are ready to convert to ICD-10 on Oct. 1, Hock said.

Two recent House bills, which scored backing from the American Medical Association and The Heritage Foundation, have recently recommended delaying, transitioning or scuttling implementation. But both are seen as unlikely to go anywhere.

The American Medical Association has said the staggering number of new codes in ICD-10 will burden physicians who want to concentrate on quality care, and lead to reimbursement denials. While ICD-10 is used around the developed world, there are various adopted versions in different countries, and the U.S. is among the few to use the International Classification of Diseases to reimburse providers and physicians.

[Also: ICD-10 bill surfaces, calls for delay, more study of rollout disruptions]

“Any time you go through a massive change, implementing a new IT system, you’re going to have claim issues,” Hock said. “First and foremost, be prepared to minimize denials. I’m wary of someone against moving to ICD-10 just because we’re going to have denial.”

The Heritage Foundation released a report this week recommending the codes not be used for payer reimbursement, but Hock said that too is a bad idea.

“A move away from using ICD codes for reimbursement would be a massive change for U.S. healthcare. If we think there’s a lot of heated debate now, the idea of totally changing the way we reimburse, I think that would be an even more interesting discussion.”

It’s taken 30 years to approach implementation of ICD-10 in the United States.

[Also: New ICD-10 bill asks for transition period]

The World Health Organization began work on ICD-10 in 1983, and completed it in 1992. However, it took until 2015 for the U.S. to implement it, Hock said.

The WHO released an early ‘beta version’ draft of ICD-11 in 2012, with the first full draft scheduled for release in 2017. Add time for feedback, edits, politics and IT upgrades and an ICD-11 timeline might also drag on, Hock said.

Hock promotes ICD-10 for boosting the ability for providers and payers to know more about what’s going on with a patient.

Stack argues that ICD-10 is problematic in this area. That it requires a level of specificity clinicians say they may not be able to provide. Others say some of the codes are just plain nonsense.

There are codes for getting struck by a macaw; sucked into jet engine, subsequent encounter; stabbed while crocheting; and the often ridiculed, burns due to water skis on fire.

Hock laughs too, but under the root of the fun, is the rationale, he said.

“A lot of the codes are getting at what caused the injury, or this particular diagnosis,” he said.

In the current code set, there’s nothing between the first encounter and second encounter. There’s no differentiation between medical procedures that use an open approach to those that are minimally invasive, he said.

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“It’s critical for health systems to understand how to provide better care,” he said.

Payers too will have more information to determine what happened, and how much to pay, he said.

While some in revenue cycle might argue this gives payers another reason to deny claims, in a health system moving from fee-to-service to value of care, knowledge is power.

“Think about the power,” Hock said, “knowing why patients ended up in the hospital in a country trying to manage burgeoning healthcare costs.”

Twitter: @SusanMorseHFN

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