White Paper: The Impact of ICD-10 on Cardiology and Physician Documentation

On October 1, 2015, the ICD-9 code set used to report medical diagnoses and inpatient procedures will be replaced by ICD-10. A more extensive and granular code set, ICD-10 allows for greater specificity and exactness in the reporting of medical diagnoses and inpatient procedures. As such, its use is expected to bring a number of benefits to cardiology providers including more accurate reimbursement claims and payments for inpatient procedures, improved disease management and higher quality information for measuring healthcare service quality, safety and efficiency.

To accommodate the change, which comes after more than 30 years of utilizing ICD-9, coding practices must become more consistent with current medical practice, while providers must begin to document with greater specificity. The payback will be significant, but the path to achieving it is fraught with challenges.

With more than 69,000 unique diagnostic codes and 72,000 procedure codes, ICD-10 contains more than eight times the number of codes used in ICD-9 and will require extensive preparation and training in order to document to the specificity required under the new code set. In addition, ICD-10 introduces alpha characters to both procedure and diagnosis codes and can include anywhere from three to seven digits. ICD-9 codes contained no more than five digits.

This transition will be particularly burdensome for cardiology providers, as more than 12,000 new cardiology-specific procedure codes are included under ICD-10. For example, the ICD-9-PCS code for insertion of a non-drug eluting coronary artery stent translates to 48 different ICD-10-PCS codes with five additional documentation concepts, including root operation, number of sites, approach, type of device and blockage site.1

As a result, accurate and thorough documentation is critical to ensure that providers deliver the level of specificity necessary under ICD-10. To meet these changing requirements and produce more comprehensive procedure documentation, many physicians will find it necessary to change their current documentation habits.

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The Impact on Physician Documentation

The most obvious impact of ICD-10 on physician documentation is the sheer mass of codes that physicians must learn to use in this new environment. With more than 12,000 new procedure codes for cardiology alone, learning to adapt documentation to the level of specificity required under ICD-10 will prove to be an uphill battle.

Take for instance the ICD-10-CM codes for congestive heart failure. Where in ICD-9-CM this diagnosis required only a single code, cardiologists must now alter their documentation habits and increase specificity to capture the information necessary for coders to determine which of the 14 codes this diagnosis falls under in ICD-10-CM.  Adding to this learning curve and increasing the changes to cardiology procedure documentation and coding are the additional documentation concepts for cardiology providers.

Because ICD-10 will dramatically alter the way in which procedures are coded, the impact and trickle-down effect of the transition will also touch nearly every department within the organization – from clinical documentation and coding to claims processing and reimbursement, as well as audit, compliance and risk management programs. Thus, the accuracy and specificity of physician documentation will also impact multiple software systems.

As a result, poor physician documentation will have long-term implications including inaccurate coding and billing and the loss of critical historic data. In addition, organizations that are not ready to submit claims using ICD-10 on October 1, 2015 will be subject to multiple cascading financial risks, including enormous direct impact to the timing and amount of reimbursements and audit outcomes, and thus, the bottom line.

ICD-10 Planning Efforts

With less than a year until organizations must utilize ICD-10 for procedure documentation and coding, planning efforts should be well underway in order to meet the October 1, 2015 deadline. Included in this should be a thorough assessment of all systems and processes that will be affected by the transition, as well as identification of those systems that must be updated or altered. In addition, physician and coder education and training and clinical documentation improvement (CDI) are key.

At this point, organizations should have successfully completed system and process assessments and drafted related action plans, budget projections and project timelines. In addition, communication should be underway with internal staff and physicians, as well as payers and stakeholders, regarding the number of changes that can be expected in the coming year.

For those organizations that have not completed these tasks, the time is now, as planning efforts must quickly advance to more involved processes that rely on the completion of these steps. Included in this is extensive training for both physician and coders.

In an ideal state, organizations would already be switched over to ICD-10, as there is nothing stopping them from documenting to the degree of specificity required for the new code set. In fact, a growing number of facilities are or soon will be coding in a dual ICD-9/ICD-10 environment to ensure coders and systems are fully ready for the transition, and to assess staff productivity, financial impact and other issues.

This level of training will play a key role in organizations’ planning initiatives, as provider education will ultimately translate to improvements in clinical documentation, which will be key to a successful transition to the new code set. In addition, these improvements will also mitigate the risk of miscoded, rejected and improper reimbursement claims, thus improving the revenue cycle and enhancing the bottom line.

Automation to Streamline the Transition to ICD-10

While improving current processes through education and training is key, leveraging technology to automate procedure documentation and coding can streamline the transition to the expanded code set and shorten the learning curve for cardiologists.

By guiding cardiologists through the procedure documentation process, these systems ensure that each procedure is documented with the level of specificity and granularity required to ensure appropriate coding under ICD-10 and allow cardiologists to efficiently capture robust detail from even the most complex procedures.

In addition, automation eliminates the human errors that often lead to incomplete documentation and incorrect coding, streamlines reporting for American College of Cardiology (ACC) data elements and mitigates the impact of Medicare Recovery Audit Contractor (RAC) audits.

The Future with ICD-10

While the transition to ICD-10 will be burdensome for those who have not undergone thorough assessment and planning, the new code set will bring a number of benefits to cardiology providers in both the short- and long-term. Included in those benefits is a better understanding of healthcare outcomes, as well as the value of new procedures, improved disease management and higher quality information for measuring healthcare service quality, safety and efficiency.

The reality is that ICD-10 can be used to drive organizational change for quality improvements. For instance, with more extensive diagnostic and procedure coding, ICD-10 will allow providers to more easily identify patients in need of disease management and will enable organizations to develop more effective and tailored disease management programs.

With a number of systems being impacted by the transition, including scheduling, medical records abstracting, laboratory and radiology information systems and departmental systems for the cardiac catheterization lab, ICD-10 will also be a driving force in organizations evaluating and redesigning existing technologies, systems and processes to enhance patient care.

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1 Amato, M. & Knight, N. (2013, August 20). ICD-10-CM – Implementation, System Readiness, & Training. Poster session presented at the MedAxiom Business Office and Coding Network Comprehensive Cardiology Coding Workshop, Nashville, TN.