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Debate over ICD-10 Future Leaves Medical Practices Struggling in Present


The AMA is working to stop the transition from ICD-9 to ICD-10. Does that mean medical practices should stop preparing?

There are a lot of rumors swirling around about ICD-10. Will the AMA be able to “kill” the rule? Will the government acquiesce to physicians and hospitals? Should I ignore all the hype? Should I get ready for ICD-10 no matter what?

The AMA and all the state-based AMA organizations have started an eleventh hour campaign to stop the change from ICD-9 to ICD-10, which, to be honest, is a bit humorous. Initially, the AMA was all for the transition.

Then they started to get feedback from their members and realized what a royal pain in the neck this would be. Higher IT costs, higher software costs, and higher involvement by the physician in the documentation area with a very high level of drilling down to the proper diagnosis. The time a physician would take in documenting the detail does not necessarily guarantee better care for the patient. In fact, some physicians say that it takes too much time away from the patient.

The one example I like to point out to illustrate how “over the top” the degree of specificity is in ICD-10 is the diagnosis for non-union of fracture. In ICD-9 there is one diagnosis code. In ICD-10 there are 1,400 diagnosis codes. I am not sure what difference there is in a diagnosis of fracture of humerus (right, left, or unspecified) in the first visit versus a subsequent visit. And, for that matter, why do they even have an unspecified code? They told us the whole reason for ICD-10 was to drill down to more precise codes for reporting. So why would they even include an unspecified code? Just asking.

So now the question is, will the AMA be successful in stopping the implementation of ICD-10? There are people in both camps of thought. Some think yes they can stop the insanity. Others think that CMS and the rest of the government will push through ICD-10 the same way they pushed through 5010 and not give the doctors a break. Since one of the main points of transitioning to 5010 was to be able to handle the codes from ICD-10 that camp may very well be correct.

We know the AMA is fighting ICD-10 implementation. We know the hospital organizations are, too. We also know that the government is determined to get these transitions accomplished. Who will win? I believe we won’t really know until after the November 2012 elections.

Now, I have heard some people say that all the “noise” going on about ICD-10 should be ignored. They think that the transition can’t be as catastrophic as many are saying. I believe those people have not really thought through all the ramifications of the transition. The government programs are sure to delay if not deny payment if the most specific possible diagnosis code is not used. I would bet money that the commercial carriers will do the same.

Also, there are those carriers, workers’ compensation and automobile insurance companies come to mind, which will not change to ICD-10. So, in order to be able to get claims processed by all carriers, a medical provider will need to have a system that can handle ICD-9 and ICD-10 at the same time. That ability will cost money. The practice management software, as well as EMRs will need to be able to be flexible. As we all know, flexibility in writing code for software is never easy. “Not easy” translates into expensive.

In a time when the reimbursement to physicians is constantly being attacked, lowered and decimated, I’m not sure how a physician’s office will be able to afford the more sophisticated software programs. When a medical provider is faced with spending money on technology - or spend the money on supplies, rent or overhead - the provider sometimes cuts corners on technology and or billing people, which in turn makes his reimbursements get decreased or delayed. This is an ugly, viscous cycle.

The last question to consider, should a medical provider get ready for ICD-10 or not? Whether or not ICD-10 is implemented does not really effect what a physician should do. As I stated in an earlier blog, the physician and office should review their most common diagnosis codes and see if they can’t be more precise now. For example, 401.9 is unspecified hypertension. I am betting that by the second or third visit (if not sooner) the doctor knows full well whether the hypertension is benign or malignant. So, I believe it behooves all medical providers and their billers/coders to be as precise as possible in the documentation and billing.

Perhaps if everyone was more precise and would drill down to the most specific diagnosis code now, they would not have as much problem adapting to ICD-10 and they would be much more precise for ICD-9. That is just good coding.

Find out more about Sue Irwin and our other Practice Notes bloggers.

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