Part 3: Understated aspects of ICD-10 for coders

Carl Natale
by Carl Natale

It might be that IT or finance guys lead the ICD-10 charge, but there's little disputing who the foot soldiers are: medical coders. Indeed, coders will be the ones to put ICD-10 into practice on October 1, 2013 and beyond.

While forthcoming technologies and ICD-10's greater specificity promise to make coding easier in the long-run, as of now many issues and questions linger. In the first installment of this series, ICD10Watch examined the Top 3 understated aspects of ICD-10, and then followed-up with 3 more understated aspects of ICD-10.

Since, a trio of coder-centric ICD-10 facets surfaced:

1 ICD-10 will result in a streamlined claims process
It's not easy finding a coding expert willing to testify that ICD-10 will make the lives of their brethren smoother in the short-term but some experts agree that, in good time, ICD-10 will be easier than ICD-9.

“The change to ICD-10 should significantly impact the entire claims process as there will be less need to get additional information after the claim has been sent,” explains Kathryn DeVault, a professional practice manager at AHIMA.

DeVault also expects ICD-10 to result in fewer coding mistakes, thanks largely to improved logic, standardized definitions in ICD-10-PCS, more accurate clinical terms in ICD-10-CM. “With the more specific code descriptions in both systems the result should lead to a decrease in coding errors.”

What's more, ICD-10 is better suited to computer-assisted coding, aka CAC, and new tools are already coming to market to make coding more efficient.

[Related: Will ICD-10 spark coder chaos? Podcast: On coder shortages and other ICD-10 challenges.]

2 Payers' hands are tied
As a matter of law, come October 1, 2013 providers must submit codes in ICD-10 or expect their claims to be rejected. Unfortunately, the way things stand today, it really is that simple.

The reality: Payers are legally and financially responsible for not only adhering to but also administering regulations among their providers.

CMS insists as of now that October 1, 2013 will be a switch-flipping day, on which ICD-10 will be turned on and ICD-9 essentially turned off. 

“If we’re forced to enforce compliance, and our providers are not sending us compliant transactions we have no choice but to reject those transactions,” explains Dennis Winkler, Blue Cross Blue Shield Michigan's director of technical program management.

3 Proficient ICD-10 coders will write their own ticket
And guess who's going to pay them?

Think of this situation-to-be much like consultants during the lead-up to Y2K. Winkler does. “If you remember back to Y2K, a COBOL programmer was worth his weight in salt. And contractors were jumping for 50 cents on the hour increase in the billing rate, there was no allegiance, there was no nothing,” Winkler adds. “So you had this contingent workforce that were naming their price and their hours and floating wherever they needed to for about 3 years.”

And, yes, the same could happen with ICD-10. “People that know ICD-9 and have been trained in ICD-10,” Winkler continues, “oh my goodness, they’re going to be walking on water.”

As we saw in the previous installment of this series, The AAPC's (American Academy of Professional Coders) Rhonda Buckholtz agrees. “Prices will go up with demand and services might not be ready for you to be compliant,” she commented.

As ICD10Watch previously reported, ICD-10 will create career opportunities for coders, and other healthcare professionals. The good news is that smart coders will be able to chart their own professional course and ICD-10 has the potential to actually make coding easier.

It's not so much the bad news as a reality check but, come deadline day, coders and the organizations that employ them had better be using ICD-10, or expect payment and cash flow disruptions, to say nothing of government-issued fines.

[Reader poll: Which ICD-10 related cost is of most concern to you? Come by ICD10Watch to vote, please!]