ICD-10 Benefits – Where are they?

One of the interesting topics of discussion at HIMSS was around the delay of ICD-10. However, I have yet to find an answer to what I think is probably the most important question around ICD-10. I posted the question and some other thoughts related to the question on the EHR Guy’s passionate post about ICD-10. Here’s my question and comments:

“What are the true benefits to using ICD-10?”

I’ve read story after story about ICD-10 (including this post) and so far I’ve only seen people giving general lip service to the basic idea that more specifically quantified data will somehow have a benefit to the healthcare system. Darren in the comment above says, “The fact that ICD-10 helps so many electronic and quality initiatives right now, or as pointed out above, are, in fact, required to achieve them”

What are the electronic and quality initiatives to which he speaks? What are the true benefits that we’ll get if we go to ICD-10? I haven’t seen enough of these examples.

We could also look at this same question another way. The rest of the world has been using ICD-10 for a lot longer than us. What have been the benefits that the rest of the world has seen from their use of ICD-10 that we haven’t seen in the US since we’re still on ICD-9?

I’m not trying to say that there aren’t benefits. I’m just saying if there are, then why aren’t we hearing more stories with concrete examples of the benefits? If there are, I’d love to see them and make them more widely known.

The EHR Guy offered this reply:

What you are asking for is reasonable and fair.

I will post, in a future blog, examples of why migrating to ICD-10 has beneficial clinical quality outcomes other than the intended reimbursement aspect of it which has been the main purpose of implementing it here in the United States.

But in essence a deep specificity would eliminate the erroneous coding accompanied by bulk documentation to justify the claim to be reimbursed.

Achieving semantic interoperability with erroneous coding is impossible. I’ve been in aggregation projects where abstracting information from HL7 messages was futile because no one in the healthcare organization seemed to understand what was contained in them.

This will be a very lively topic for months to come. I look forward to your participation in the discussions.

I look forward to the EHR Guy offering some more concrete examples in future blog posts. Although, I think this question deserves much more attention. I’ll admit to not being an expert on ICD-10. I know enough to be dangerous. So, I’d love to hear some of the real life benefits that ICD-10 has provided other countries and/or the benefits the US will get from ICD-10 implementation.

If we don’t have more stories and example of these benefits, then instead the stories related to the cost and inconvenience of ICD-10 (which are easy to find) will dominate the conversation. If that’s the case, then we can be sure that ICD-10 will be delayed.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

14 Comments

  • Any organization that is looking at improving health outcomes using evidence based reporting will benefit from moving to ICD-10. It’s true that there is greater specificity in ICD-10 but how does that help?

    Let’s say you’re a researcher and you’re looking at the post-operative infection rate by surgical method for cholecystectomy. Using ICD-9 you have the option of two codes – one for open another for laparoscopic. ICD-10 however, provides you with 15 codes – which provide information on not only the approach, but additional details such as the use of balloon, basket, robotics, electro hydraulics and laser. There is also information on whether the procedure included bile duct exploration or stone extraction within the codes.

    Based on the specificity of those 15 codes, using current surgical methods your post-op infection research can pinpoint those modalities which offer safer outcomes in terms of post-op infection rates. The code itself can provide highly detailed information without having to comb through the full patient record to glean the details one ICD-10 code can provide. The result is faster and more consistent reporting.

    In addition, there is room left in ICD-10 to add codes for new surgical technology as it becomes available.

  • Another concrete example of I-10 specificity that would be useful has to do with patient noncompliance with therapy. Currently, I-9 has two noncompliance codes: one for dialysis noncompliance and one very general noncompliance V code. Rather than the generic noncompliance V code – I-10 provides options that distinguish specific reasons for patient noncompliance such as intentional (i.e. patient could not afford their medication) and unintentional (patient’s age or debility). This type of specificity would be useful in determining reasons for re-admissions and/or targeting a population in need of other community services to prevent or minimize unnecessary hospital re-admissions.

  • Thanks for asking the right question. So far the comments are what we have been hearing for three years. I do not think they answer the question about how ICD-10 contributes to solving the current complexity of healthcare in the USA. While it may be true that it gives researchers better information, it does so with increased complexity in day to day practice. I am waiting to hear how this will make things better for my clients and their pocketbooks.

  • In the short run, for individual patients ICD-10 is not likely to reduce costs. ICD-10 is a tool to assist healthcare providers make population based health decisions that can, over time, reduce costs. ICD-10 provides a foundation for systemic cost reductions through:
    “1. More-accurate payments for new procedures
    2. Fewer miscoded, rejected, and improper reimbursement claims
    3. Better understanding of the value of new procedures
    4. Improved disease management
    5. Better understanding of health care outcomes.” (1)

    (1) (Libicki M, Brahamakulam, I; Rand Corporation, The Costs and Benefits of Moving to the ICD-10 Code sets,2004. http://www.rand.org/pubs/technical_reports/2004/RAND_TR132.pdf)

    The paper cited above provides a thorough analysis of the complexities around ICD-10 and the costs of benefits of moving to it. The analysis is able to delve into the complexity around the topic of conversion which is difficult to fully explore in a blog. It’s a pretty good read!

  • Healthcare is continually advancing. This much I know. My 40-year career in nursing has witnessed tremendous advances in knowledge, diagnostic capabilities, procedures, treatments, pharmaceuticals and electronics—ones that I never could have imagined in when I started nursing school. I see the move to ICD-10 as yet another advancement. How?

    The ICD-10 code set provides a means through which the diagnoses, treatments and procedures are so much more explicitly described than ever available in ICD-9. The finer detail of ICD-10 gives our nation consistent data that can be gathered , analyzed, understood, and applied to care provision guidelines. The result? Better quality in healthcare; as quality ties directly back to evidence based practice and evidence is garnered when detailed and consistent data can be.

    From my viewpoint ICD-10 moves us into an era in which care is provided that is supported by data. Data which is detailed, specific, gathered and disseminated electronically, and shared broadly to impact quality of care in a accelerated manner. This is the most important benefit of ICD-10.

    Now let me find some specific examples!

  • Dianne provides good information.

    And to pose a question to Doc DeVore:

    Why do you think that enhancing medical research will not help your patients?

    I undertstand the urgent and emergent nature of some medical practices and the really big costs require better understanding and new, improved procedures and tools to address – understanding, tools and procedures that ICD-10 will help to reach.

  • @Steve Sisko
    That is a very fair question, and when rereading my comment of March 9, I see that I should clarify. I do agree with Diane, Doris and others when they talk about the long term benefits of better information. I do not question that, and can support that. My concern is how to answer my 81 year old mother’s question, “what does this do for me today?” In some cases, quite a bit. For example, I recently suffered through what some call “swimmer’s ear.” ICD-9 code Acute serous otitis media, 381.01, does not indicate whether it is left or right ear or both, and does not allow for indication of recurring but not chronic problem. H65.05 does that. My question is: does it matter? It might. Mom recently had a hip joint replacement. Her second such procedure in three years. Knowing that the second time is her right hip might help speed payment but really has no other short run benefit, but having Z96.641 and Z96.642 in her history will be useful to a better understanding by future providers.

    These are not the best examples of how ICD-10 will benefit, but do illustrate my concern about the short term learning curve to code correctly. Increased specicifity will be of great benefit long term. In order to get providers behind the effort is going to require telling the story of those benefits with better examples than what I have used here. Until then my mother will be like the AMA – what’s in it for me TODAY? Yes, I know that’s the wrong question, but it is the question being asked.

  • Let me amend my earlier comment about no short term benefits. Doc D, thank you for jogging my memory. The fact that ICD-10 captures laterality is significant for short term benefits.
    This time, I have burnt my right hand during my work as a chef. Using ICD-9 my right hand burn is submitted as code 944.8 – Burn of wrist(s) and hand(s). If I am a clumsy cook, and burn my left hand the following week, code 944.8 will be submitted, again as a new claim. However, because the code is the same as for both, my second claim is likely to be rejected because it is seen as a duplicate claim.
    In ICD-10 the codes would reflect that the two injuries were for different sides of the body and there would be less likelihood of claim rejection. In short, coding in ICD-10 would reduce the need for the back and forth dialogue about the duplicate claim and the claim could be processed faster. Savings in time/cost as well as less hassle for the clumsy cook. There are many benefits like this, none of them alone are earth shattering, but taken together can produce real benefits to patients and physicians.

  • You bring up a good point Doris. We often speak of improving patient care and do not address the overall experience of the patient (and guarantor).

    Surely faster and accurate payment should make everyone happier and increase their overall experience. And the last thing that many people working to improve their health and condition are hassles and run-arounds having a financial impact.

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