“ICD-10 is a way for patients to be put into specific categories so we can use that for specific purposes,” such as epidemiology, said Dr. Doug Fridsma, CEO of the American Medical Informatics Association. “The value is really for the folks that collect that information who'll have much more granular ways to analyze the data in those buckets. There is going to be less benefit for the individual doc and greater benefit for the epidemiologist.”
Still, it's expected to take several years of data collection before ICD-10 data will prove their worth in quality improvement and comparative effectiveness research.
Experts say it's key for clinicians to provide sufficiently detailed documentation in the medical record so coders can properly prepare claims for submission. Required information for ICD-10 includes the side of the body that's involved in the care, the cause, and the frequency. For example, ICD-10 code W21.11XA designates “struck by baseball bat, initial encounter.”
Before ICD-10 goes live, Advocate Health Care plans on having experts come in to talk with its physicians about the need for full documentation, said Dr. Anupam Goel, vice president of clinical innovation.
Coders at Advocate Lutheran General Hospital in Park Ridge, Ill., have been coding in both ICD-9 and ICD-10 for the past several months, said Dawn Monegato, the hospital's coding manager. Dual coding reveals documentation gaps. “It resonates with the physicians more if you can show them your documentation and the need for more specificity,” Monegato said.
One question still unanswered is whether the benefit derived from the increased granularity of ICD-10 data will be offset by a potential increase in errors because of the greater complexity of the codes.
What's likely to be needed at the clinician level, even after ICD-10, Fridsma said, is an increased use of even more descriptive codes, such as Snomed. “Once you get into alternative care models, it becomes more necessary to describe the clinical condition,” Fridsma said. “The good thing about Snomed is, it's more descriptive, but it's like the English language in that there are multiple ways to describe the same thing, which is its blessing and its curse, and that may be better for these new alternative payment methods coming down the pipe.”
Work by the World Health Organization on an ICD-10 successor code set, ICD-11, is already well underway, with a beta version already being tested. The target release date for a working version of ICD-11 is 2018. The good news is that there is collaboration between developers of Snomed and the WHO.
“They're really trying to create a single system that incorporates the ability to describe things like Snomed and categorize things like ICD-10,” Fridsma said. That should make the next leap forward to ICD-11 a little easier, he said.