How ICD-10 has Impacted Healthcare

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Group of healthcare professionals discussing workThe World Health Organization established the International Classification of Diseases (ICD) to standardize medical records. ICD-10 is an update that reflects changing needs in the medical field. The code has provided increased detail and flexibility over the last ten years. However, implementing the code presents medical establishments with several challenges. The biggest challenge is finding qualified personnel to handle the increased workload created by the transition.

How ICD-10 Impacted Healthcare over the Last Decade

Over the last ten years, the ICD-10 framework has allowed caregiving institutions to increase reporting details using fewer codes. [1] The system now reflects contemporary medical practices and also allows caregivers to notate complex combined procedures with detail and accuracy. Additionally, ICD-10 coding follows a common theme across the entire framework, streamlining workflow compared to ICD-9 codes. Most importantly, ICD-10 has kept pace with changes over the last ten years, a feature overlooked in ICD-9 development. As time goes on, ICD-10 will continue to facilitate improvements in caregiving operations. These five areas affect how caregivers process patient information.

One: A New Identification Scheme

A report authored by the American Medical Association outlines the differences between ICD–9 and ICD-10, such as the addition of two characters and more alpha characters that increase the available classifications from 13,000 to around 68,000 codes. [2] The framework provides more classification flexibility and allows caregivers to provide more accurate service information.

Two: Increased Coding Workload

Caregiving facilities suffered from coding personnel shortages well before the ICD-10 transition. [3] The medical community’s almost four-decade reliance on ICD-9 resulted in a minimally supported coding education environment. Upon ICD-10 implementation, many organizations had no other choice but to rely on offshore coding services. Due to the update, the Bureau of Labor Statistics forecasts an almost 40,000 coding job opening increase between 2010 and 2020. To date, many organizations still struggle to procure coding personnel. Adding to the problem is that many veteran coders choose retirement over learning the new framework. Because of these complications, federal legislators extended the deadline for healthcare organizations to adopt ICD-10 by one year.

Three: New Challenges and Opportunities

ICD-10 is the most monumental coding change in almost 40 years. [4] While many organizations and administrators perceive the framework’s long-term benefits, they have come to realize the transition to the new standard is a challenge. Despite this inconvenience, caregiving institutions recognize that ICD-9 no longer supports contemporary medical operations. On a positive note, the ICD-10 coding framework arrives at the perfect time for healthcare providers to exploit the detailed information using big data analytics. These two developments will drive service delivery improvements by improving provider collaboration, community wellness and doctor-patient relationships.

Four: A More Complex Accounting Workflow

The new framework permeates throughout the entire medical practice revenue cycle. In a relatively short time span, ICD-10 has reduced many issues involving care provider procedure recording and reimbursement. A report authored by Alexa Arends-Marquez, et al. on the American Health Information Management Association (AHIMA) website forecasts that ICD-10 implementation will initially slow processing. [5] Caregiving facilities will experience backlogs in information processing such as:

  • Scheduling
  • Pre-certification
  • Pre-registration
  • Estimates
  • Registration
  • Case Management

Caregivers will have to educate staff members and patients on adapting to the new system and providing or obtaining the right information to complete processing. Additionally, caregiving facilities will have to revise their procedures to accommodate the new system. The ICD-10 system will affect caregiving finance departments’ ability to perform billing, collections and reimbursement operations. Billing includes processes such as:

  • Late charges
  • Electronic data interchange (EDI)
  • Discharged not final billed (DNFB) accounts
  • Transaction code frameworks

Collections and reimbursement processes that ICD-10 may affect are:

  • Cash acceleration
  • Claim denials
  • Self-pay collections
  • Electronic remittances
  • Payment processing
  • Financial reporting
  • Payment structures

Due to the many areas that ICD-10 will affect, accounting errors will increase, creating the possibility that overwhelmed finance departments will leave many procedures un-coded.

Five: Revised Documentation Procedures

For coding professionals, ICD-10 implementation means learning a new way to document and process claims. [6] The new system will increase workloads by almost 70 percent and may result in more patients leaving facilities before finalizing the billing process. The new system is also likely to increase the number of patient charts on hold due to coding discrepancies. The ICD-10 system promises to serve the medical community’s classification needs, while adapting to future changes. The system offers physicians a way to record details that may improve caregiving, but implementing the framework is a complex and challenging undertaking. Between universal healthcare, the aging population and ICD-10 implementation – healthcare information technology professionals have never been more important in the medical field.

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If you are interested in pursuing a career in health informatics, consider enrolling in the online Master of Science in Health Informatics program at  the University of Illinois at Chicago.