CHIME Time: Does ICD-10 delay really bring relief?

My earliest recollections of ICD-10 are associated with slight panic. Near the start of my career as a chief information officer, I had a conversation with a very anxious departmental specialist in the early 1990s about our need to quickly prepare for the imminent shift from ICD-9 to ICD-10. I did some research and soon had in my possession an electronic copy of the new ICD-10 codes and two leather-bound versions of the code books.

It appears as if we were a little too reactionary.

As of early May, the CMS is intending to set Oct. 1, 2015, as the new deadline for transitioning to ICD-10. In the time since, there's been no shortage of opinion on whether the delay is a bane or a boon.

The delay does not necessarily bring relief to a CIO. First, consider the pace at which these professionals have been running for the past several years and the interrelated timing of projects –not just from a regulatory compliance perspective (federal requirements for ICD-10 and meaningful use Stages 1 and 2 and soon to be 3), but also from a software lifecycle perspective. Many system vendors included both the Stage 2 code changes along with the code and database changes for ICD-10; you can't postpone one without the other. So there is no actual relief, and the delay only kicks the can down the road from a coding and compliance standpoint.

The ICD-10 coding structure has been around for 20 years, and there are many reasons why the U.S. has tarried in adopting it. With the October 2014 deadline looming, the industry was pressing hard to meet it; post April 1, many in the industry now feel like the air traveler who is ready to board, only to see the flight delayed, yet again. Based on most of the discussions I've had, it appears that many in the industry are ready to board flight ICD-10 and get this plane off the ground.

Lost in the debate over the delay are all the reasons why we should get ICD-10 into use. The benefits, especially as health reform moves forward, are many:

• Determine severity and prove medical necessity. Physicians can use ICD-10 to ensure the chart reflects patients’ acuity to a third-party payer, auditor or the public. It provides a basis for evaluating resource consumption and the patient care that was provided.
• Ensure a provider’s strong reputation. With the changes prompted by value-based purchasing, documentation becomes something like a physician’s social media presence—anyone can see it. After care is provided, documentation becomes the basis for ICD-10 coding, which will more accurately reflect the quality of a physician’s care.
• Reduce audit hassles. ICD-10 provides a way to allow the physician’s documentation to be translated into a more accurate clinical picture, reducing the chances of misinterpretation by third parties, auditors and attorneys.
• Control costs, improve cash flow and streamline claims processing. Greater coding specificity reduces the need for payers to request copies of medical records; this could mean fewer claims denials and more timely payment.
• Provide a more precise definition of fraud, waste and abuse. Imprecision of the current data, including the ICD-9 codes, can create a fog that masks inappropriate billing for services.
• Improve chances for success under value-based care. Because ICD-10 demands more accurate documentation and gives physicians more diagnostic choices to capture new data, the system is likely to ensure that clinicians are optimally paid for the work they perform.

Getting ICD-10 operational is only partially an IT issue; I see it more as a business issue, where we utilize a more precise tool to help us improve care-delivery processes. A delay might give us a moment’s respite, but can we really afford to wait any longer?