Anesthesia Management: Early ICD-10 Adoption Reveals Problems Less Widespread than Anticipated

Countdown to ICD-10

Good news on the coding front: With more than half its coders already using ICD-10 diagnosis codes on a daily basis we have found that the acute documentation and productivity problems many feared would overwhelm the ICD-10 transition have not materialized.

We began shifting coders to the new code set in December 2013 via an in-house application that automatically converts ICD-10 codes to ICD-9 for claims submission. The software, coupled with extensive training, has allowed the company to get a running start on the Oct. 1, 2015, national adoption deadline.

The whole rationale behind our early adoption program was to gradually phase in ICD-10 in order to get our staff acclimated and proficient, and to be able to work with our customers to make sure their documentation supported the new codes. Taking this approach has allowed us to get ahead of the curve and learn a lot of valuable lessons.

Default Code Eases Transition
One of the most important of those lessons has been the revelation that the documentation deficiencies many feared would sabotage ICD-10-coded claims have so far not been an issue.

Basically what we’ve discovered is that if you can code the clinical document in ICD-9, there is an extremely high probability that you’ll be able to code in ICD-10. Clean claims are going out with the appropriate diagnosis codes, and that’s a huge relief for a lot of people.

The smooth transition may be in part due to concerted physician efforts aimed at providing the level of encounter detail required by ICD-10. It is more likely that the general absence of problems stems from the expansive ICD-10 code set, as well as the coding leeway provided by the Centers for Medicare & Medicaid Services (CMS.)

ICD-10 allows coders to use an unspecified code when documentation specifics are lacking. When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code.

For example, if the clinician fails to document which hand has been affected by an injury, the claim can nonetheless be pushed through with an “unspecified” code.

That while the clinical specificity at the heart of ICD-10 is essential to improved financial and clinical analysis, quality measures, disease surveillance and overall quality improvement, the unspecified code was established as an interim tool to make it easier for the physicians to make the transition to the new system.

Over time I think that the use of unspecified codes will be phased out.

Despite the flexibility provided by the unspecified codes groups that currently have clinical documentation returned for additional information, or that experience high denial rates in ICD-9, will likely face significant issues when transitioning to ICD-10.

Productivity Largely Unaffected
In addition to highlighting the absence of major documentation problems that the serious productivity declines many anticipated with the transition have not occurred. The healthcare industry last year warned that practices could see a drop in coder productivity of up to 60% for as long as six months after implementation.