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Readers Write: ICD-10 is a Win for Patients

October 21, 2015 Readers Write 4 Comments

ICD-10 is a Win for Patients
By Ken Bradberry

There has been conversation about how the ICD-10 transition will impact unsuspecting patients. Maybe a procedure is delayed due to an inaccurate code or a bill is incorrect. These things will almost certainly happen. While the first days have gone by without significant disruption, it is inevitable that bumps will occur, as with any major technological implementation.

The real story is how much patients have to gain from the transition. ICD-9 was over 30 years old and didn’t keep pace with the dramatic advancements in the healthcare industry. Consider this short list of examples:

  • Laser and laparoscopic surgeries were not performed at the time ICD-9 was implemented, but are common medical techniques today.
  • Treating a heart attack 30 years ago was generally limited to medications to treat pain and an irregular heartbeat. Today, doctors can quickly evaluate what is causing the attack and treat accordingly – bust clots with new drugs, insert a stent to prop open a narrowed vessel, even sew new vessels into the heart during surgery.
  • The first HPV vaccine approved by the FDA in 2006 has significant potential to prevent cervical cancer and is widely recommended by the Centers for Disease Control and Prevention for girls and young women.

This is just the tip of the iceberg in terms of how far medical advancements have come in the last 30 years. There has also been significant change in our health with newly discovered medical conditions and the rate at which diseases are diagnosed. For example, the CDC reports melanoma rates have doubled over the past 30 years, but chickenpox cases in the United States have dropped sharply since the vaccine became available in 1995.

Clearly the healthcare landscape today is almost unrecognizable from where it was 30 years ago. Patients have different healthcare concerns and conditions and have many more options for prevention and treatment.

ICD-10 has about five times as many codes as ICD-9. The codes are much more specific in describing a diagnosis and treatment plan, allowing for providers and payers to have a more detailed and accurate conversation about a patient’s care. This will not only improve accuracy of statements and bills received by a patient, but also improve health safety and outcomes.

Here is an example of ways a patient may benefit from ICD-10 throughout the healthcare experience:

  • Diagnosis. During a routine medical exam, a spot is detected on a patient’s lung that requires additional investigation. The healthcare provider orders a series of procedures that require ICD-10 coding to be completed. Because ICD-10 codes are more granular, scheduling the procedure with the right resources is more likely, and therefore a more accurate and timely diagnosis is possible. The precision offered by ICD-10 will not only lead to a more precise diagnosis, it will also provide the provider with more insightful information to guide treatment plans.
  • Eligibility determination. This same patient has health insurance which requires testing, procedures, and treatment to be authorized. The ICD-10 codes provide the payer more specific information on the services being provided, which can result in a timelier eligibility determination. This can avoid unplanned cost to the patient and frustration working through a billing issue.
  • Quality outcomes. Improved clinical documentation under ICD-10 will help reduce medical errors and also lead to more meaningful discharge data that can help reduce readmissions.

In order to quickly navigate the hiccups caused by the massive transition and quickly get to the point where patients are experiencing real benefits, it’s critical for all stakeholders involved in the delivery of care to choose a partner who can successfully lead them through the complexity of ICD-10.

Ken Bradberry is chief technology officer of Xerox Commercial Healthcare.

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Currently there are "4 comments" on this Article:

  1. Wow, wow wow, Ken. You are obviously not a provider. ICD-10 will do nothing to improve care.
    1. Your spot on the lung example….There is only one code for neoplasm of uncertain origin of the lung. Same as ICD-9.. It is NOT more granular. It is not a better code to order the correct tests. It will not make the diagnosis more timely, how does ICD-10 help that? Providers do NOT use ICD-10 codes (or ICD-9) when we speak to each other, determine treatment plans, or improve precision of diagnosis. ICD-10 is solely used for billing, and possibly data for others to collect, but in this case, your unknown spot on the lung, it does NOTHING to improve care.
    2.Thanks for confirming ICD-10 is for eligibility/billing. We don’t know the granular specific diagnosis when ordering tests, we are trying to use tests to gather information to make a diagnostic decision. I do NOT read an MRI report and say oh, its an M16.12 so I know what is happening. Thats silly.
    3. ICD-10 will do NOTHING to improve quality outcomes. Hear that again. Codes make NO difference in quality outcomes. EVER. It will NOT reduce errors, nor lead to more meaningful discharge data that will reduce readmissions. That is just ridiculous.

    This is a glaring example of a typical puffery language piece that shows that we really need to get non-providers out of the business of medicine. Terrible. Ken do something else.

  2. Thank you for your very a candid comments. It’s understandable that ICD-10 has created such a visceral response, change can be difficult. We know that healthcare providers do not speak in “ICD codes”. The fact is Patient outcomes can improve with ICD-10. One of the primary reasons is that ICD-10 can reduce the need for the use of “unspecified” or “not elsewhere classified” codes. The more granular the coding, means richer analytics that caregivers can use to support clinical decision making. I agree with you, their are better examples, the point is more detailed analytics can provide better diagnostic insight and clinical decisions. It’s critical that ICD-10 is properly implemented in your healthcare organizations to ensure your caregivers can realize the benefits ICD-10 has the potential to provide.

  3. I am neither a provider nor a payer, but it seems to me to be quite a stretch at this point to argue the value of ICD-10 to a patient. A quick story of the experience I have had as a patient with ICD10. I went to one of my providers yesterday to have my lab drawn (standing lab order). They told me that the standing lab order I had had expired because it was ordered under an ICD9 code and I needed to contact the ordering provider to get it resubmitted with an ICD10 code. That was a big win for me let me tell you… I am sure there are plenty of other like stories out there.

    Now perhaps over time ICD10 will help improve quality by providing the granularity you speak of IF and that is a big IF the codes can be effectively used by providers etc… But the reality is that we have so much room for improvement in healthcare, pick any one of the dozens (hundreds?) of articles out there talking about the billions to even a trillion dollars in waste currently in healthcare, that patients likely would have been fine without ICD10 and with providers and payers just finding ways to use the data they have effectively.

  4. Bryan,

    I don’t expect we will see immediate results with ICD-10 and the transition from ICD-9 could be painful for a while. We have used the same coding system for 30 years, so the transition will take time to realize the benefits. You are correct that iCD-10 is only one of several upgrades and improvements we need to make with our healthcare system. Is ICD-10 the panacea for all patient care issues, no but it’s a reality now and we should work to take full advantage of the additional data and opportunities to improve our healthcare system.

    Ken.







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