Does ICD-10 Make Sense?
By Katie Wike, contributing writer
Providers have opposed ICD-10 since the beginning and that opinion hasn’t changed over time
Health IT Outcomes reports that CMS has promoted ICD-10 as a way to remove existing ICD-9 codes which are “30 years old, have outdated terms, and are inconsistent with current medical practice” by implementing new codes that provide room for growth. “The structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.” Despite this - and claims that ICD-10 will lead to more efficient payment - providers are slow to embrace the initiative.
“From a physician’s perspective, it doesn’t seem to make much sense,” agrees Juergen Fritsch, Chief Scientist at M*Modal, in an interview with EHRIntelligence. But Fritsch argues ICD-10 is needed, saying, “There is just no way for ICD-9 to accurately capture the advances of medicine from the past 30 years. There’s nowhere to put new codes in the existing structure. In order to track diagnoses and procedures for accurate reimbursements, the industry needs ICD-10.”
Fritsch notes for physicians to become more accepting of ICD-10, “They’d have to buy in to the bigger premise about getting richer data and more fine grained data for billing purposes. But from a clinical perspective, I wouldn’t say it makes that much sense. For a physician, I can see why they struggle with that.”
Dan Riskin, MD, CEO and co-founder of Health Fidelity agrees, cautions not to expect too much with regards to analytics, telling HealthIT Analytics, “ICD-10 will only give us minimal bang for the buck. The reason is that the challenge is not that we’re lacking granularity. Our weakness is that we don’t have a rational infrastructure. We’re starting, but we don’t have the breadth of content we need to adequately represent the patient. All we have is this tiny bit of claims data, but the best we’ve ever gotten is 20 percent of clinical information into claims data. So ICD-10 is trying to make that tiny bit of claims data just a little better."
While acknowledging ICD-10 is a step up from current coding, Riskin concludes, “It’s not something I would recommend to base your analytics capabilities off of. It’s one source of information, and you definitely want to include it in anything you do, but it’s not going to be sufficient to really get insights into your patients.”