SAN FRANCISCO -- Nearly 65% of clinical documentation doesn't contain enough information for coders to use for billing under the upcoming ICD-10 coding system, a coding expert said here at the American College of Physicians annual meeting.
The switch to the new coding system will greatly increase the specificity of diagnostic codes, and most doctors don't provide enough detail for office coders to translate that to ICD-10, said Rhonda Buckholtz, vice-president of ICD-10 education and training at AAPC, a medical coding society based in Salt Lake City, Utah. Her estimate of the percentage of charts that were inadequately documented came from a survey of patient charts done by the AAPC, but further detail on the survey was not provided.
Complicating the switch for physicians, most payers said they won't reimburse for unspecified codes, which are commonly used by doctors who may not know how to exactly diagnose a patient when they see them, she said. "Under ICD-10, if we're not ready, we're not going to get paid."
Doctors have bemoaned the switch to ICD-10 -- short for International Classification of Diseases, version 10 -- because of the tremendous increase in complexity from the current ICD-9. The number of diagnostic codes will increase from nearly 14,000 to around 69,000. The number of procedure codes will jump from around 3,000 to roughly 87,000.
ICD-10 requires much greater detail on location of ailments, cause and type, and complications or manifestations compared with ICD-9. For example, diabetes will require complications to be incorporated within a single code. And asthma is listed as "mild," "mild intermittent," "mild persistent," "moderate persistent," or "severe."
Therefore, Buckholtz said physicians need to start work now to ensure they will provide enough information for billers to properly code.
Like it or not, the ICD-10 coding switch will occur on Oct. 1, 2014, a date the Centers for Medicare and Medicaid Services (CMS) has stood firm on after delaying the launch by a year already.
Jeannine Engel, MD, from the University of Utah School of Medicine in Salt Lake City, said studies range from 4% to 11% in the amount of extra time they estimate doctors will spend because of ICD-10.
Complicating the issue for physicians, ICD-9 won't be going completely away next fall. ICD-10 only applies to patients covered under HIPAA, the Health Insurance Portability and Accountability Act, so Workers Compensation patients -- who aren't covered under HIPAA -- will still be billed under ICD-9.
Buckholtz provided a number of tips for physicians, including:
- Review contracts with health plans and see what additional information they need or what will be changing
- Test systems and procedures before October 2014 to make sure your office is ready to go
- Budget costs of the change
- Train and educate clinicians and other staff members on the changes they need to make
- Update forms, documentation, and internal processes
"You don't want to wait 'till the last minute because there's no quick fix for ICD-10," Buckholtz said.
CMS has produced tip sheets, handbooks, and other content to aid providers on the transition, Dickon Chan of the CMS regional office in San Francisco told attendees. The agency also hosts periodic teleconferences and sends updates via email.
Chan recommended providers not focus on the more than 100,000 codes in ICD-10, but zero in on the ones that are most applicable to their practice. "You don't need to know every single number in the telephone book, but when it's there, you need it," he said.
John Guzek, MD, an internist at Commonwealth Health in Scranton, Pa., attended the talk and said the changes aren't as extreme as he first thought. He'll note what changes there are.
"I've downloaded an app on my iPad to look at the ICD-10 codes," he told 鶹ý in a video interview. "I'm probably going to be looking through that and seeing what the differences are going to be."
Engel said ICD-9 was first employed in 1975 and hasn't been updated much since then.
"Would you use a 30-year-old cardiac stent? Probably not," she said. "With medicine, 30 is pretty old."
Engel argued that the more granular data will provide insurers and researchers with additional information to track public health risks and quality data, and to design payment systems.