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Beyond ICD-10 in a Galaxy Far, Far Away!


A long time ago in a galaxy far, far away, it is October 1, 2015 and new HOPE has come about. We have come through a period of civil strife; rebel space ships — forcing a complete change to our coding system — have ceased to strike from hidden bases. A little history on this struggle — the World Health Organization created the basis for ICD-10 in 1994. The Clinical Modification (CM) was added in the U.S. by the National Center for Health Statistics to create ICD-10-CM for use in inpatient and outpatient diagnosis coding. The move to mandate this new coding system for all healthcare providers created great consternation throughout the galaxy.

What came next to this now peaceful world? Believe it or not coding has improved. Coders have regained their ICD-9 levels of productivity; excellent training and preparation made this possible. Claim submission speed and accuracy are at an all-time high. The increased demand for medical coders has leveled off and has actually fallen in some areas of the galaxy. Coders have begun to work as billing consultants and training leaders in healthcare facilities across the universe.

The cost of this war has been high. The Centers for Medicare & Medicaid Services (CMS), sometimes referred to as the Dark Force, has estimated the cost to be in excess of $2 billion dollars. Many archaic billing systems and processes have been either upgraded or completely replaced, after much hand-wringing.

What have been the repercussions of this battle? Many facilities, that had no processes in place for clinical documentation improvement (CDI), have now established them, and documentation has steadily improved since the end of the war. With greater specificity in the ICD-10 codes, and the ability to reimburse based on those procedure codes, many new medical procedures are being performed. Couple this with the improved CDI and the healthcare universe is experiencing better patient outcomes. Hospitals where these procedures are being performed are experiencing improved performance scores, and with their increased patient preferences are seeing overall improved financial results.

The expanded codes in ICD-10 are enabling improved payments for new procedures, because these procedures can be more finitely coded to ensure appropriate payments. The industry is seeing fewer rejected claims, thereby eliminating the administrative costs typically associated with reviewing these rejections.

The new ICD-10 coding structure has improved the coding process. With the improved coding structure and more accurate clinical terminology, educated coders are having an easier time selecting the proper diagnosis and/or procedure codes, improving coding timelines and reducing errors.

Overall – one year after this struggle ended — the results are:

  • Improved measurement of quality, safety, and efficacy
  • Enhanced reimbursements
  • Improved research data for clinical trials and epidemiological studies
  • Improved tracking of public health risks
  • Improved data collection for electronic health records (EHR)

Be prepared – there will be a sequel to this battle — it is projected that ICD -11 will be ready by 2015 or 2016. Stay tuned!

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