With providers scrambling to make final preparations for the looming ICD-10 code transition, most haven’t had a lot of time to focus on the long-term benefits the coding change will produce.

But ICD-10 proponents believe the changeover’s improvements will be dramatic and ultimately lead to enhancements in the way providers are paid, how diseases are managed and the manner in which research and public health are pursued in the U.S.

“For months, the focus has been on making sure that the transition goes smoothly and does not result in major productivity declines or cash flow disruptions,” said Cindy Slocum, the ICD-10 implementation project manager for web2pro Business Performance Services (web2pro). “Assuming those worst-case scenarios are avoided, organizations should fairly quickly begin to see the benefits of the new system.”

As an example Slocum said that the enhanced specificity in ICD-10 should decrease the number of pended claims for requests for medical records since the new code set will provide the information not included in ICD-9 codes today. Reducing administrative overhead costs associated with re-processing claims is a win that both payers and physicians will derive benefit from.

Boosting PQRS reporting

No increase in the physician pay schedule is slated to accompany the implementation of ICD-10 in October. But the system’s capacity for reflecting greater clinical detail will allow physicians to more accurately report the care they do provide, and this should lead to more appropriate reimbursement and potentially fewer denials.

In addition, the ability to gather granular clinical data will likely help reporting for the Physician Quality Reporting System (PQRS.) The program, which initially offered bonuses for successfully completing a range of process measures or steps, will begin assessing financial penalties from providers who fail to meet reporting requirements in 2015.

Stronger disease management

In the longer term, the new code’s granularity should also support higher reimbursement for new procedures, disease management programs, and other services that involve a range of complex or integrated steps and capabilities. Slocum said ICD-10 data will likely be central to developing equitable reimbursements schemes in an accountable care setting. Equally important, clinical improvements should also flow from the additional information.

Better disease management will be supported by ICD-10 through improvements in screening, prediction, disease identification, treatment and compliance. For example, ICD-10 provides multiple divisions for type 1 and type 2 diabetes mellitus, along with a dramatic increase in the number of sub-classifications to create a more flexible and responsive code.1 The additional information can improve clinical management by allowing doctors to better select the most appropriate treatment for a specific patient,2 make earlier interventions, and more effectively track treatments and conditions.3

Similar refinements are expected to have an impact on the treatment of asthma, heart disease and other chronic illnesses.

Improved research data

In the area of public health and research, ICD-10 is expected to generate new insights by illuminating heretofore hidden patterns and relationships across disease, treatment and outcome spectrums.4 The data will also allow for more precise evaluation of new medical procedures, and eventually enable providers to measure their performance and outcomes against their peers.

Interestingly, ICD-10 will additionally create a better understanding of medication non-compliance, according to Marybeth Regan, PhD, a healthcare solutions expert with IBM Global Business Services. In a 2012 American Health Information Management Publication, Regan noted that ICD-10 will provide options to capture information on medication adherence, including reasons for non-compliance, such as a lack of financial resources.5 This is an important development, given that up to 75% of adults are, or have been, medication non-adherent in one or more ways.6

Slocum said the many positives of ICD-10 will become more apparent once the long-awaited transition is complete.

“It’s true that most organizations are focused almost exclusively on the October 1 date right now and not looking further to consider how they may benefit from ICD-10,” Slocum said. “That’s understandable, given the complexity of the transition and the financial stakes involved. But despite the dread many are feeling, I am confident that we will survive the transition and that ICD-10 ultimately will prove to be a boon for healthcare. The only question is how soon we get there.”

1Marybeth Regan, “,”For the Record, American Health Information Management Association, May 7, 2012.
2Shelly K. Schwartz, “,”Physicians Practice, Oct. 16, 2013.
3Marybeth Regan, “,”For the Record, American Health Information Management Association, May 7, 2012.
4Sue Bowman, “,” American Health Information Management Association research library, (originally published in the Journal of AHIMA 79, no. 3, March 2008)
5Marybeth Regan, “,”For the Record, American Health Information Management Association, May 7, 2012.


About the author

web2pro Business Performance Services offers services and consulting to help hospitals, health systems, and physician practices improve business performance, boost margins and transition successfully to value-based care.