ICD-10’s Current Impact on Coding

April 2016 marks six months since the long-awaited implementation of ICD-10. In addition to the vast increase in the number of codes in both ICD-10-PCS and ICD-10-CM, changes continue to unfold in reimbursement models. For better or for worse, there's never a dull moment in the current administration. 

 

Let's look at some of the ways coding has been impacted in the last six months. Productivity slowdowns were widely anticipated with the adoption of ICD-10. Many experts predicted a decrease in the realm of 50 to 70 percent. AHIMA's report on the transition of one Ontario hospital from ICD-9-CM to ICD-10-CM in 2002 found a significant drop in productivity, with recovery to 20 percent below pre-ICD-10 levels one year later.

 

What Has Been the Reality of ICD-10’s Impact on Healthcare?

For one hospital in Florida, the impact has been less severe than anticipated. A 695-bed, level 1 trauma healthcare facility, University of Florida Health Jacksonville, encompasses inpatient departments (including SNF, psychiatric, rehab, OB), interventional cardiology and radiology, a GI lab, and multi-specialty outpatient clinics. In addition, it is a participant in the CMS Comprehensive Care Joint Replacement Model. University of Florida Health Jacksonville reports a 20 - 30 percent decrease in productivity since the implementation of ICD-10, as measured by CDI interactions, special chart reviews, abstracting, and systems review. It will be interesting to see trends as we move forward.

 

Another measure of the challenges in transitioning to ICD-10 is the rejection rate for Medicare claims submitted since October 1, 2015. Initial data from CMS showed the following metrics for October 1 - 27, 2015. Rejected claims have increased, but not by a huge percentage.

  View original image for best view.      NOTE: Metrics for total ICD-9 and ICD-10 claims rejections were estimated based on end-to-end testing conducted in 2015 since CMS has not historically collected this data. Other metrics are based on historical claims submissions.

View original image for best view. 

NOTE: Metrics for total ICD-9 and ICD-10 claims rejections were estimated based on end-to-end testing conducted in 2015 since CMS has not historically collected this data. Other metrics are based on historical claims submissions.

How Are Coders Fairing?

In addition to becoming familiar with the new numbers themselves, coders are experiencing expanding parameters in their roles in the healthcare environment, especially in the hospital setting. Of particular importance is the need to develop more extensive knowledge of procedures. Understanding and applying root operations and multiple code assignments provides the basis for correct coding for an entire episode of care. The coders' work has become more fully integrated with hospital operations, and the knowledge base and competencies of coders are major components of maintaining compliance requirements. In the era of ICD-10 and new reimbursement models, coders need to have a firm grasp of hospital-acquired conditions, as well as the ability to correctly identify and to employ risk adjustment factors.

 

Change is here, and by and large, healthcare is adapting. Coding has become even more critical in the revenue cycle of the hospital, as well for as the optimization of public health efforts. Even experienced coders need more training and skills acquisition. The future is now.