Oncology & Hematology Coding Alert

ICD-10-CM is likely to introduce more accountable care. 

Your providers may have questions and concerns for the change that ICD-10-CM will introduce later this year. Since the implementation time is fast approaching, it is important you help them keep focus on the positives of the upcoming change and handle the challenges this change is likely to introduce. Having your providers on board is going to be key to the success of a practice’s ICD-10-CM changeover.

Joe Nichols, MD, a member of CMS’s ICD-10 Task Force, during the agency’s “ICD-10 Clinical Documentation” provides answers to key provider concerns in a webinar. We present here the top 5 complaints your providers may have for ICD-10-CM. Read on to find what experts have to say about these complaints.

Complaint 1: “There are way too many new codes to learn.”

Response: ICD-10-CM code additions vary widely per specialty, Nichols said. “There are some areas where we see a very substantial increase in the number of codes, and some areas where the codes actually go down.” 

Whether or not you have to face a huge number of new codes will depend on your specialty. If, however, you are in a field where the number of codes has increased, you shouldn’t have to change much about the way you document, he added.

Complaint 2: “ICD-10-CM won’t help me clinically take care of my patients.”

Response: Although physicians may not feel like the ICD-10-CM code set will make patient care any different, that is not necessarily the case. “We have to think broader than that,” Nichols said. 

“Healthcare crosses a boundary of time and providers. That patient is going to see someone else over time and will have different conditions…and as clinicians we really should try and be leaders in the industry to provide accurate data and analyze what’s happening in healthcare.”

Note: This may especially be true if providers are documenting the specifics about the disease they are assessing and treating. “For instance, the provider should be documenting not only the confirmed condition, but also the specifics, such as the location, type, severity, cause, etc of the of the condition based upon how the disease can be better described clinically as directed by the ICD-10-CM choices listed. Including this information in the note may paint a clearer picture on the nature, progression and scope of the patient’s condition leading to improved documentation quality, better communication and collaborative care among providers over time leading to more accountable care,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc.

Complaint 3: “ICD-10-CM isn’t relevant to me because I’m on the outpatient or professional side and I don’t get paid based on diagnosis codes.”

Response: “Even in ICD-9-CM, we have codes that factor into payer processing rules in terms of the determination of appropriateness, measures of quality, pay for performance, compliance, and contracting decisions,” Nichols said. Although payment is not specifically tied to the diagnosis code, these codes have always been important from a business perspective.

However, “as we move into ICD-10-CM and toward a new accountable care, value-based purchasing environment, diagnosis codes will factor more and more prominently into different changes in reimbursement models that are being proposed within the industry today,” he said. “A lot of these reimbursement models aren’t looking just at what was done, but why.” Therefore, even if your payments aren’t tied directly to your diagnosis codes right now, that could change in the future.

“For many, caring for patients who have chosen a Medicare Advantage plan (Medicare Part C), affects long-term reimbursement rates based on the condition and severity of certain illnesses,” Loya says. “Those illnesses are reported with ICD codes.  For now under the current set, ICD-9-CM, codes may more broadly allow higher reimbursement to be justified with a less specific method of reporting, however when using ICD-10-CM more detail regarding the severity, laterality, causes or causal nature and resulting combinations of illnesses will require more specific information to be documented to justify reporting the more specific code affecting the annual ‘member rate’ to be adjusted (up or down) for Medicare’s HCC reimbursement model.”

Complaint 4: “We should just wait until ICD-11 comes out.”

Response: Although this is a common pushback, it isn’t reasonable, Nichols said. “ICD-11 is not slated to come out until 2015, and if we look at the historical implementation and just do the math, it could be 2039 before we see ICD-11 implemented, given the history of how we’ve implemented the codes in the past,” he added. “We’ve got a code set that’s already 30 years old — we can’t wait another 30 years to move forward.”

Complaint 5: “We should go directly to using SNOMED for diagnosis coding.”

Response: SNOMED-CT (which stands for Systematized Nomenclature of Medicine – Clinical Terminology) is more clinically focused, but was never designed to be used for disease classification, Nichols said. In addition, SNOMED is even bigger than ICD-10-CM, with over 300,000 codes. “Many of the stakeholders in the industry really are not familiar with SNOMED,” Nichols added. “I believe SNOMED coding is actually even more complex than ICD-10-CM.”