How long will ICD-10 coding be relevant?
It's that time of year for year-in-review articles. And as I mentioned Wednesday, it's impossible to review ICD-10 developments without focusing on the latest ICD-10 delay.
Dr. John Halamka can't avoid that observation in his review of healthcare IT issues in 2014 either. But he quickly pivots into some observations worth noting:
- ICD-9-CM is incomplete.
- ICD-10-PCS is too complex and inadequate documentation is almost guaranteed.
- Healthcare productivity loss will be enormous.
- Clinicians should focus on SNOMED-CT instead of ICD codes.
- The fee-for-service business model is going away — making ICD coding irrelevant for billing.
Halamka never has been a fan of ICD-10 coding, but he never cracked a flaming water ski joke. He regretted the resources needed to make the ICD-10 transition possible.
He has thoughtful ideas about healthcare and how IT can impact it. With that in mind, consider the last two points in the list above.
SNOMED is a terminology for clinicians. It's incredibly specific so that it can be mapped to classification languages. It's not a replacement for ICD coding — which is the reporting end. But adopting it can be the way for clinicians to ride out the ICD upgrades.
Which is wonderful. But I have to wonder. If medical coders will need more documentation to assign ICD-10 codes, that still means clinicians will need to improve their documentation processes.
Unless Halamka is right about ICD codes becoming irrelevant.
No more fee for service?
Conventional wisdom behind healthcare reform says the problem with healthcare is that the system incentivizes procedures not health. The doctors ordering unnecessary tests to make more money are the boogey men of healthcare.
So accountable care organizations are being created to manage patients' health and reward healthcare providers for achieving health. Does that mean they will not be reimbursed for procedures?
That may be true, but that doesn't mean MRIs and tests will be free. Someone is going to charge someone for procedures. And healthcare bean counters will demand some sort of accountability.
And ICD diagnosis codes will be required to track those outcomes.
I'm not criticizing Halamka for not being able to chart the evolution of healthcare in a year-in-review post. It's a complex, unpredictable industry. The points he makes are hints at what is changing. This is a challenge to what we know. Be ready to leave it behind as we move into a new year.
This is a good time to remind everyone that the deadline to apply for April's ICD-10 testing is Jan. 9. (Medical Practice Insider)
There is a lot of good info on clinical documentation. What it boils down to is that physicians need to round up all the clinical information into their notes. It doesn't require memorizing codes. (Journal of AHIMA)
- Cardiologists will have to relearn codes and definitions.
- Nephrologists will have a challenge with ICD-10 codes for chronic kidney disease.
- Neurologists will have more specificity (complexity) with diagnosis codes.