Wound Healing Through Medical Data: Get Ready for ICD-10-CM Classification Improvements

  The healthcare industry is facing the most revolutionary update it has seen in more than 30 years – the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM). The compliance date for implementation of ICD-10-CM is Oct. 1, 2014, for all covered entities of the Health Insurance Portability and Accountability Act. From a timeline prospective, the World Health Organization developed ICD-9 for worldwide use and the US developed the clinical modification (ICD-9-CM), which is currently used today, in 1979. Let’s face it, ICD-9-CM is outdated for many reasons while healthcare technology has changed and will continue to be innovated. As such, ICD-9-CM cannot support any new initiatives.

Setting ICD-10 Straight

  It is necessary to tackle fears and myths contributing to inaccuracy of the upcoming ICD-10-CM data system. First, many entities believe ICD-10-CM was developed without clinical input, which couldn’t be further from the truth. A number of medical specialty societies contributed to the development of the coding systems, including the American Academy of Dermatology. Second, is the myth that there will be unnecessarily detailed medical record documentation requirements that will put a hardship on providers. Studies have demonstrated much of the detail contained in ICD-10-CM is already in the medical record documentation, but is not currently needed for ICD-9-CM coding. Third, there’s the belief that an increase in the number of codes will make ICD-10-CM “impossible” to use. CM codes are designated for use in documenting diagnoses and are moving from 14,000 ICD-9-CM to 68,000 ICD-10-CM. But just as the size of an increased dictionary doesn’t make one more difficult to use, to the contrary, it’s easier to find the right code. ICD-10 will be much more specific, clinically accurate, and a logical structure, as well as considerably easier to use than ICD-9-CM. Finally, people are worried that ICD-10-CM-based super bills will be too long or complex to use. However, it’s important to note that practices may continue to create super bills that contain the most common diagnosis codes used in their practice. Neither super bills in ICD-9-CM nor ICD-10-CM provide all possible code options for many conditions.   ICD-10-CM aligns seamlessly with Health 2.0, which refers to a number of related concepts including telemedicine, electronic medical records, mobile devices, and the use of the Internet by patients so that they can have greater insight and control into information generated about them.   The benefits of ICD-10-CM can empower the future momentum of Health 2.0 by: –     • measuring quality, safety, and efficiency of care;     • conducting research, epidemiological studies, and clinical trials;     • setting health policy;     • designing payment systems;     • improving clinical, financial, and administrative performance;     • preventing and detecting healthcare fraud and abuse; and     • tracking public health and risks.   Primary changes for ICD-10-CM are in its structure and code format. Table 1 compares/contrasts ICD-9-CM and ICD-10-CM.   The new structure has the ability to be easily expanded to allow for flexibility, reflection of current medical terminology, and expanded detail that’s relevant to ambulatory and managed care encounters. The format of the index and tabular list of ICD-10-CM is eerily similar to ICD-9-CM, with a few minor exceptions: Chapter restructuring and sense organs (eye and ear) are separated from the nervous system chapter and moved to their own chapters. The index remains the same, with the main terms listed in alphabetical order and indented sub-terms listed under the main terms. For ease of identification, ICD-10-CM continues to support an alphabetic index of diseases and injuries, alphabetic index of external causes, table of neoplasms, and table of drugs and chemicals. Also, ICD-10-CM codes will continue to be identified by diagnostic terms in the alphabetic index, then verified by the character coder in the tabular list. The new features allow for greater specificity and clinical accuracy as the medical code data begins the lead indicator for future healthcare data analytics. The use of data analytics with ICD-10-CM can begin to predict financial models, improve quality of patient care, and facilitate evaluation of medical processes and outcomes — all with the goal of lowering costs.   There are some examples that lend themselves to reimbursement and quality problems with ICD-9-CM. Let’s take a patient who presents with a decubitus ulcer on the right upper-back, who, a month later, develops the same ulcer on the left lower-back. ICD-9-CM does not identify left versus right, let alone the specificity of the back. With ICD-10-CM, the assignment will have laterality and site specificity for the back. Also, note that the staging was unspecified, which will continue to drive to a single ICD-10-CM code: laterality, site, and staging. Currently in ICD-9-CM, it takes two separate codes to identify both site and stage. By adopting the new coding system and incorporating greater specificity, the clinical information results in improved ability to measure healthcare services and decrease the need to include supporting documentation with claims.   With a number of countries already using ICD-10-CM (including United Kingdom, Australia, and Canada), the time is now for the US and its healthcare providers and entities to embrace the power of the new coding system. Fears, myths, and anxiety aside, the healthcare community has been underserved by an outdated coding system for so long that it has quite literally “dumbed down” the ability of qualified healthcare providers to translate 21st century medicine into reportable codes. Now, it’s time for US healthcare providers to show what they know with the robust ICD-10 coding system and to begin to report 21st century medicine. ICD-10-CM will allow healthcare individuals, groups, and organizations to adopt and embrace this change in the revolution of medical code data in which it speaks … and all will have to listen. In preparation, wound care providers should begin to review their most frequent ICD-9-CM diagnosis codes and possible systems and applications affected by the groundbreaking change. Andrea Clark is chairman, CEO, and founder of Healthcare Revenue Assurance Associates, Plantation, FL.