You made it. Well done. Congratulations.
It has been a long and challenging road. We just went through this conversion at the radiology group where I am CIO. As challenging as it was, ICD-10 is an important bridge to improving health care and a great first step into the future.
Let’s take a minute and remind ourselves why:
• ICD-10 helps communicate a clear clinical picture; for providers, payers, and patients
At the end of the day, ICD-10 is about ensuring clinicians have a complete, accurate clinical history prior to—in radiology’s case—a patient being referred for imaging. This clinical history is relevant and important because it enables physicians providing care to have a more complete patient picture so they understand what may or may not be really occurring with that patient’s health.
It is all too common in today’s instant-gratification, “don’t-waste-my-time” world that the reason for exam/clinical history of a patient may say simply “Pain.” Ok…so…where is said “Pain?” Is this a first or repeat occurrence? If it is a repeat, what prior information is available related to this “Pain?” Are there prior exams or at least prior reports?
More information will help with improved quality and speed of diagnosis. Plain and simple.
• ICD-10 ensures accurate measures of quality and efficiency
Certainly, radiology has not completely identified accurate measures of quality and efficiency yet (let’s just admit the debate continues). ICD-10 codification creates consistent views of reasons that patients are referred (ie, clinical history) and what examinations were performed (relating back to CPT codes).
From a reimbursement perspective, CMS will be able to connect this information to outcomes, which will help to drive improved quality and efficiency. If a patient has a set of clinical indications that require follow-up examinations, this consistency produces a specific positive outcome that is good for patients.
• ICD-10 captures levels of risk and severity
As providers start to better track clinical indications, procedures performed, and resulting outcomes, we can relate all of this data back to risk/severity of risk to make better decisions at the beginning of how to care for these patients. In the era of continued discussion around imaging utilization and clinical decision support, the ability to feed data back into the process to improve it at the outset is imperative. Again, data is knowledge, and knowledge is insight and power.
• ICD-10 supports clinical research
Today, too much patient clinical history is locked away in physician notes; it is not properly identified, codified, and available for research. Providing a more complete set of codes related to the reason a patient is seen enables clinical researchers to draw conclusions that help us create better outcomes in the long term.
• ICD-10 supports proper payment and reduces denials
It is interesting that a common theme for ICD-10 is financial, specifically the fear of an increase in denials, addendums, or lack of payment. I understand the United States to be the only health care system to tie ICD-10 to payment/reimbursement, often making the conversation focus on financial issues vs. clinical issues and patient outcomes.
What doesn’t get mentioned is that, when implemented correctly, patient histories will be better documented with a more appropriate and specific clinical history based on procedure and anatomic region. This can enable clinicians to provide more complete care. And payers can reduce denials and increase reimbursement for necessary procedures. It is the lack of documentation that creates these denials—ICD-10 enables us to address this once and for all by being focused on quality outcomes at the outset.
• ICD-10 is just better patient care
Any physician will tell you more information is better…but more structured information is what they need. It can improve the time treating patients by making use of the right information available at the point of care—whether it is a radiologist interacting with images, or a PCP interacting with patients.
So we are at the start of a beginning. Pat yourself on the back. Have a small piece of cake in the break room.
The real benefits begin now.