HIMSS News

ICD-10: Curse or blessing for small practices?

Shah PareshBonnie SundayI have been practicing primary care for 26 years now, which means I have been practicing my ICD-9 coding for 26 years as well. If I had spent as much time practicing guitar, I would be a virtuoso by now. But I didn’t, and I’m not. Oddly enough, I’m not a virtuoso at ICD-9 either.

Providers feel bombarded by the need to meaningfully use EMR’s, prepare for PCMH/PCSP certification and stay on top of the day-to-day operations of the medical practice. If 14,000 ICD-9 codes cannot be mastered, what hope is there to master 68,000 ICD-10 codes? However, look at the superbill – does it contain 14,000 ICD-9 codes? It does not. Just as providers learned the most frequently used ICD-9 codes, they will become familiar with the ICD-10 codes that are relevant to their specialty.

Healthcare is transitioning from fee-for-service to value-based reimbursement. The better we take care of our patients, the higher our income. Population health reports, clinical decision support and patient registries depend upon accurate ICD coding. Utilizing the more specific code set available in ICD-10 will enable more robust use of these tools to provide our patients with the safest and highest quality care.

In addition, shared savings arrangements reward providers for providing efficient care. This can take the form of a percentage of cost savings given to the provider as long as certain quality thresholds are attained. The cost savings are calculated by subtracting actual costs from expected costs. Expected costs are calculated using algorithms that take into account the complexity of individual patients. These algorithms use ICD codes submitted on the claims for services rendered by the provider. By using ICD codes that capture the complexity of a patient’s condition, the provider facilitates the accurate calculation of expected costs. A patient with complications of diabetes will have higher expected costs than a patient without diabetic complications. The increase in the number of ICD-10 codes compared to ICD-9 codes will allow for more detailed description of medical conditions and their complications, giving small practices the opportunity to accurately document the complexity of the patients in their panel.

Resources are available to help small practices with the transition to ICD-10. The following websites are a good place to start: Road to 10; HIMSS ICD-10 PlayBook and AHIMA. In addition, providers can contact their specialty societies, state and local medical societies, clearinghouses and payers for ICD-10 resources and support.

By embracing the ICD-10 code set, providers in small practices can position themselves to benefit from the higher specificity of ICD-10 codes. This will result in healthier patients, healthier practices and ultimately…happier providers!

Dr. Sunday is board-certified in Family Medicine. She graduated from the State University of New York at Buffalo (UB) School of Medicine and completed her Family Medicine Residency at St. Vincent's Hospital in Erie, PA, where she was chief resident in her third year. She also serves as an adjunct faculty member in the HIT program at Canisius College and is a consultant for HEALTHeLINK™. Bonnie is a member of the HIMSS ICD-10 Task Force.

Paresh Shah founded MindLeaf Technologies, Inc as a Medical Compliance & Medical Administration Services Company. Prior to founding MindLeaf, he worked for Digital Equipment Cor.p and GTE Government Systems in various software implementation/consulting roles. Mr. Shah has a Masters from Boston University and an MBA from Babson College. He is a member of HIMSS ICD-10 Task Force.