HIMSS: ICD-10ready or not?

LAS VEGAS—Amidst the evolving timeline for a transition to ICD-10, the prospect of postponement is a plus, Robert S. Gold, MD, CEO of DCBA in Atlanta, said during a Feb. 20 session focused on documentation improvement at the 2012 Healthcare Information Management and Systems Society (HIMSS) annual conference. Gold likened the ICD-10 transition to the Y2K preparation scare and offered that a longer timeline allows organizations to market the new codes to medical staff and gives vendors an opportunity to improve software to meet physicians’ needs.

Nuts & bolts
The basics of ICD are unchanged. The physician documents symptoms, diagnoses and procedures in the medical record. These data are extracted and assigned an ICD code. The codes are fed into a computer, which develops severity-adjusted evaluations.

Severity-adjusted data are critical for physicians, explained Gold. “Data can tell them ‘my patients are sicker.’” More severe diagnoses or more complex procedures translate into higher reimbursement. The data also affect hospital and physician report cards and insurance rates. “These data are analyzed by everyone paying physicians.”

There is another plus to more specific coding, continued Gold. As physicians learn to document better, medical staff better understand the patients’ condition and needs, which facilitates improvements in mortality and reductions in complication rates.

The hitch is that the 14,000 codes in ICD-9 may not have allowed for a sufficient level of severity. The 68,000 codes in ICD-10 could meet the bar.

The delay
Gold asserted the U.S. is not ready for the conversion to ICD-10. The issue is converting physicians to the system, but there is good news. The specificity required in ICD-10 (etiology, anatomic site, severity, other details) is typically contained in physician documentation, but not in code form.

Computer-assisted coding and EHRs have not matured sufficiently to assist physicians, claimed Gold, who identified two major problems.

The systems are static, while diagnosis evolves as the physician acquires data about the patient. In other words, diagnosis codes can evolve.

Second, pick lists, which ask physician to select a code from a pull-down menu, are faulty. Most physicians will tend to pick a single code at the top of the list. “It may be inaccurate or less severe than the appropriate code, or the condition may require multiple codes.” Gold said a decision tree model of the diagnosis could better mesh with ICD-10.

“Physicians will be ready for ICD-10 when we have the tools to help them. We need an EHR in cloud that can be accessed by all healthcare providers, a common pathway of interaction with the cloud and an app for physicians that communicates with the cloud and provides algorithms for diagnoses,” Gold said.