Healthcare reform puts ICD-10 coding in perspective

Carl Natale
by Carl Natale

This site is dedicated to helping healthcare professionals manage the transition to ICD-10-CM/PCS implementation. But sometimes we need to remember there are bigger changes and challenges.

For example, Bob Herman writes that ICD-10 implementation is one of three major healthcare issues that hospital CFOs have to juggle. He lists "volume and complexity of health IT regulatory requirements" and "lost productivity and physician documentation" too. Of course it could be argues that ICD-10 coding is part of those other two issues.

But even those three are small potatoes compared to a seismic shift in the business of healthcare: The reimbursement model is up for remodeling.

David Miller, vice chancellor and chief information officer at the University of Arkansas for Medical Sciences, an academic health sciences center, writes about  redefining the provider-payer relationship in Arkansas.

Participants identified six conditions that will be reimbursed as usual. But the cases will be reviewed quarterly to be determined if the money is spent well. If the providers kept costs below a pre-determined limit, they may receive bonuses.

Miller goes on to explain that such a system requires a lot of data and trust. Which is going to require new systems and technology. Overall, it could lead to a business transformation.

That's something that Ray Desrochers, executive vice president of sales and marketing at HealthEdge, a software company that serves healthcare payers of all sizes and types, talked to me about in an interview this week. (More on that is coming next week.) He says they are working with payers who want a business transformation. "That obviously has a huge systems and technology element to it," Desrochers says. "But also a business transformation that is relooking at how they do business and what they want to be when they grow up."

These transformations are going to be a problem because not all the states are not gathering the IT resources they will need to build health insurance exchanges (HIX). I understand the HIX are different from the healthcare information exchanges (HIE) that are needed to make the Arkansas project possible. But the HIX could be considered competing initiatives that need the same resources (time, expertise and money).

ICD-10 coding is just a piece of all these transformations.

Now that's in perspective, let's see what else we need to know this week about ICD-10 coding.

IT could end up being health reform’s highest hurdle

The article explains that states are not gathering the IT resources they will need to build health insurance exchanges (HIX). This doesn't have any direct impact on ICD-10 coding but maybe it will divert resources away from ICD-10 implementation. Or vice versa. (

How transcription becomes an important part of CDI

Lori Jayne, director of health information management at Lahey Clinic, talks about how transcription systems are part of their clinical documentation improvement (CDI) program. (ICD10 Watch)

CHI CIO Michael O'Rourke: How the ICD-10 Delay Impacts Hospitals

Michael O'Rourke, senior vice president and CIO of Catholic Health Initiatives (Englewood, Colo.), explains that hospitals have a lot going on and can use the ICD-10 implementation delay to get the transition right. (Becker's Hospital Review E-weekly)

How Clinical Documentation Improvement Could Improve the Revenue Cycle

In another example of how clinical documentation improvement (CDI) is a survival strategy, Patricia Woods, director of case management at Community Hospital Anderson in Indiana, tells how it's working at her hospital. (Becker's Hospital Review E-weekly)

How to address HIPAA 5010 edits by healthcare providers

Yes, there are still issues with HIPAA 5010 compliance. And those issues can teach us a thing or two about planning the ICD-10 transition. (ICD10 Watch)

Guest Post: Benefits of ICD-10 implementation

Dawn Duchek and Shelly Guffey of Gateway EDI list four improvements that medical practices will likely experience once ICD-10 has been implemented. (ICD10 Watch)

8 Steps to Success in ICD-10-CM/PCS Mapping

The general equivalency maps (GEMs) aren't a crutch but they can help healthcare providers understand the impact of ICD-10 implementation. Sumen De outlines eight best practices to establish precise mapping between the ICD 9 and ICD-10 code sets, (Journal of AHIMA)

Too many codes? There’s no such thing

Michelle Leppert makes the case that there may be little use for many of the ICD-10 diagnosis codes, but that doesn't mean there are too many of them. She says that the unneeded codes will not make it harder for physicians to use the medical codes they need. (ICD-10 Trainer)

Building an ICD-10 cheat sheet for obstetrics

Rhonda Butler gets specific with instructions on creating an ICD-10 cheat sheet for coding obstetrics encounters. (PhysBizTech)

Federal government seeks help developing ICD-10 quality indicators

The Agency for Healthcare Research and Quality (AHRQ) is looking for a few good healthcare professionals to help figure out how to apply ICD-10 codes to quality indicators. (ICD10 Watch)

Breeze through Your ICD-10-CM Manual With These Tips

A look at how the ICD-10 manual is organized. (SuperCoder)

Kforce Survey Reveals 70 Percent of Healthcare Organizations Moving Ahead with ICD-10 Efforts

Kforce Healthcare Solutions says 70 percent of the 300 healthcare professionals is surveyed said "said the Center for Medicare and Medicaid Services’ (CMS) proposed rule to move the compliance date to 2014 will not affect their decision to continue progress with ICD-10 planning and implementation efforts." It makes it sound like they're trying to be ready by Oct. 1, 2013. But only 35 percent have an ICD-10 steering committee. (Kforce)

Press Release Roundup

  • Siemens Healthcare, HLI partner to offer ICD-10 remediation services: Health Language, Inc. (HLI), the global leader in healthcare terminology management, today announced its partnership with Siemens Healthcare, Malvern, Pa., to offer enterprise-wide ICD-10 remediation services. Through this collaboration, Siemens customers will be able to meet ICD-10 compliance more efficiently by using HLI's LEAP I-10 tool.