Guest Post: ICD-10-CM from an optimistic coder’s perspective

Carl Natale
by Carl Natale

In my discussions with coders over the past 18 months, I have found that each coder has a reaction to ICD-10-CM as unique as the person expressing it.

Guest post by Elizabeth MorgenrothThe emotions associated with ICD-10-CM cover the complete spectrum; from joy to grief, happiness to rage, doubt to certainty. I often read Carl’s posts here and experience all of these emotions, depending on the subject matter of his posts.

For example, February 2012, when Marilyn Tavenner made the statement to the AMA that HHS was reconsidering the implementation date, I experienced feelings of uncertainty, frustration and disappointment. I had been looking forward to using ICD-10-CM since I first heard of it in 2002. For me, it has ultimately been an extended wait.

I realize not every coder shares my perception of ICD-10-CM. In fact, many coders do not share my optimism and enthusiasm. Some talented and experienced coders have expressed they will continue to code but not take the ICD-10 proficiency exam. This means eventually they will lose their credential from AAPC and no longer be a certified coder. Other coders are overwhelmed and want to retire. I belong to another cadre of coders — those who are excited for ICD-10-CM and all it entails and offers in data integration and improved communication.

Why I am enthusiastic about ICD-10-CM

Contribution to the medical field: Some physicians maintain that the specific information provided by ICD-10-CM is not clinically relevant. However, ICD-10-CM will provide, through its proper application, more in-depth information that can be compiled and used in a meaningful way after face-to-face encounters and it can be used in the long term to track clinical outcomes.
In other words, the data generated can be used to improve and facilitate the work in applied medical fields. As coders, providing accurate information carries great and invaluable significance and worth. I take the responsibility to communicate this seriously.

Contribution to reimbursement: I have participated in conversations in which individuals have maintained that diagnosis codes are not important with regard to reimbursement. I have always quickly responded that they are commonly used to communicate medical necessity for diagnostic and ancillary services, and thus serve a valuable purpose.

For most, this is an aspect of coding data readily apparent in its use value. However, I always felt that accurate diagnosis coding was important, no matter the specific service-related use applied. Therefore, I researched to see what others had to say about this very subject, and I found an excellent article which explains very well how important diagnosis code accuracy is in research. I would think that opponents of ICD-10-CM might find this article helpful in understanding how diagnosis coding might be used in improving patient care and how effectively and completely describing a patient’s condition assists a coder in doing just that.

Importance in patient care: Having a payer background, I understand how a diagnosis code can follow a patient all his or her life. If a coding mistake is made, even if a corrected claim is sent and the claim is adjusted, it remains difficult to erase this information. Also, it is difficult to ensure its intent, diagnostically and in subsequent treatment, as updated and current.
In the outpatient world, a diagnosis code may not affect whether an encounter for evaluation and management is paid, or how much is paid for the encounter, but it can still have a huge impact on the patient because it is the evaluative information attached to that encounter, potentially impacting care in the future.

Communication, communication, communication: When I have to “go back” and code in ICD-9-CM, I feel like I have golf balls in my mouth, as it significantly impedes my ability to fully and readily communicate.  ICD-10-CM, however, allows me to express or translate information with greater clarity than ever before. It provides, through its implementation, a quantifiable advantage in quality and specificity of care.

For example, if a patient has a slow heartbeat (bradycardia), to code this diagnosis with ICD-9-CM, I would have to use a more vague term, cardiac dysrhythmia, not elsewhere classified.  The ICD-10-CM code for a diagnosis of bradycardia states exactly what it is: bradycardia.

My advice to coders

The concern we have heard right here on, in a plethora of articles, refers to the enormity of the code set:  approximately 70,000 codes. In a CMS National Provider Call on Aug. 22, Sue Bowman, MJ, RHIA, CCS, FAHIMA, likened the expansion to simply having a bigger phone book. In some ways, this is a good analogy; however, it is helpful to know in advance the information you seek, making for a complexity greater than just that of a bigger field of choices or possible coded data entries.

With regard to coders, my advice has been to discard previous knowledge when seeking a code in ICD-10-CM.  If there was not a good way to describe a condition in ICD-9-CM, chances are, there may be an exact code for the condition you seek in ICD-10-CM.

For physicians who feel overwhelmed at the idea of more detail in documentation and coders who want to describe documentation accurately, I have attempted to simplify ICD-10-CM into four concepts which I find repeatedly throughout the code set.

  • Acuity: Is the condition acute, recurrent or chronic?
  • Cause: What is the cause of the patient’s condition or symptoms? For example, what is the organism associated with the patient’s pneumonia?
  • Manifestation: Is there a current complication associated with a chronic illness, such as diabetes with polyneuropathy?
  • Location (or laterality) : Where is the complication or condition located?  Is the fracture on the proximal end, shaft or distal end of the bone?  A concept associated with ICD-9 and carried to ICD-10 is whether the patient’s sinusitis is located in the frontal, ethmoidal, maxillary or sphenoidal sinus?

If there is not a code in ICD-9 for what you need, assume there is a code to describe the precise condition in ICD-10.

Many coders have committed to memory frequently used ICD-9 codes. Not unlike my colleagues, I have memorized many, many ICD-9 codes. Not to worry; I have memorized about 20 ICD-10-CM codes in the past 18 months. I do not need to know or use all 70,000 codes, but I appreciate the quality due to the expanded range and number. I doubt if I will ever use some of them; but perhaps someone else will. Even so, many coders will benefit from the advances in technology which enable them to assign codes with the use of either a computer-assisted code search tool or an encoder. Rest assured; many of these tools will be developed with the background, knowledge and expertise of other coders.

I feel confident as more and more coders learn ICD-10-CM, they will someday look back and wonder why they felt such doubt and fear as to the subsequent utilization of such precise coding.

I am also hopeful that physicians will come to appreciate and apply the benefits of these codes more fully.

Elizabeth Morgenroth, CPC, Revenue Cycle Business Analyst at T-System, Inc., has 16 years of healthcare experience in the payer, provider and vendor areas of service. While with Blue Cross and Blue Shield of Kansas, she provided coding assistance to all professional specialties statewide. Morgenroth was responsible and integral to the entire revenue cycle process for a family practice in Lawrence, Kansas with four physicians and five physician assistants. While working for Clinical Coding Solutions, she performed professional and facility coding for nearly all specialties. In her current position, she is responsible for encoder tool development and ICD-10 readiness for T-System revenue cycle solutions. Morgenroth attended the American Health Information Management Association (AHIMA) Academy for ICD-10-CM and ICD-10-PCS and is an AHIMA Approved ICD-10-CM and ICD-10-PCS Trainer.