A Study on the Impact of ICD-10 on Coding and Revenue Cycle

Implementing ICD-10 coding has been, in some ways, like learning a new language. We took a specialized task that has been repeatedly performed for over 30 years and turned it on its head with new guidelines, new characters, and new specificity that we have never had before. Many healthcare leaders have been watching for (and possibly expecting) catastrophic effects of the changes to surface after the implementation of ICD-10 such as a reduction in reimbursement and an increase in denials. A recent study commissioned by Primeau Consulting Group surveyed respondents to see how healthcare organizations are doing with ICD-10 and how they are preventing denials.

It’s no surprise that ICD-10 has led to a decrease in coder productivity. In fact, the survey showed that 66% of those surveyed had experienced some negative changes in coder productivity. Some respondents claim somewhere between a 25% to 35% decrease in productivity. I know all HIM leaders want to know if this will be a permanent or temporary loss in productivity and that is yet to be determined. When equating this productivity loss to A/R days, this can have a huge impact on the number of accounts in an unbilled status waiting for coding. Unfortunately, 34% of respondents to the survey have already seen negative impacts on the revenue cycle since ICD-10 was introduced.

In preparation for ICD-10, it was difficult to predict if additional training and education would be needed after the ICD-10 go-live. Some feedback in the survey showed that respondents did not necessarily plan for additional formal ICD-10 training for coders in 2016 but will keep up with the standard continuing education that has always been part of a coder’s job. I think this is still yet to be determined pending the results of coding audits that will show areas for education and documentation improvement.

While ICD-10 has been relatively smooth thus far, HIM leaders are still proceeding with caution and bracing for any potential downsteam impacts that could result from the drastic changes we have undergone. The study revealed that the most commonly perceived risks with ICD-10 in 2016 center on physician documentation and specificity. Again, I believe auditing will be key in determining education for coders as well as physicians.

How has the ICD-10 experience been for you? Are you seeing similar issues or risks?

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About the author

Erin Head

Erin Head

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

4 Comments

  • I’m curious as to whether anyone is focusing on the upside of ICD-10? For instance, more accurate reporting and analysis of diagnoses? More appropriate and correct decisions on coverage? To use an old favorite example of mine, I believe that 283.0 was the ICD-9 code for hemolytic anemia. Only code for an illness with numerous major and minor variations, and with a wide range of treatments that work for some of the variants and not others. Under the old code, an insurer could incorrectly disapprove – or approve a treatment that had little chance of working on a given variant. Presumably this ought to be more accurate under 10. On top of that, analysis for public health needs ought to be far more accurate.

    Short term you do expect a productivity drop. Long term, there are more codes, but with time efficiency ought to improve some, plus EHR’s may become more capable of converting a provider’s entries into actual ICD codes, or helping the coder to pick the right codes. Maybe!

    Ron

    Ron

  • Excellent point, Ron. That will be addressed in another post. Daily, I say out loud, “I love ICD-10!” because of the specific codes we now have available for diagnoses. ICD-10 definitely brings a wealth of benefits for all of the reasons you mentioned and more. Thanks!

  • I agree that there have been minimal impacts ‘this far,’ and most organizations believe the transition has gone smoothly. I would warn that the transition period is not yet over. I’d like to see if practices in particular still think everything has gone smoothly after their first post go-live audit, probably after the 1yr mark. For providers who haven’t adapted, haven’t received education, and continue to document and bill as if nothing is different there will be profound findings in those audits, with the ultimate effect of billions (nationwide) recovered by CMS RAC audits. RAC audits recovered over 4B in payer overpayments in 2012, well before ICD-10, and the changes inherent in 10 can only cause this to go up, quite possibly very drastically, and with immediate impact to private practices.

  • True. Documentation and specificity will be the key areas and auditing will play a major role in determining. The new coding system due to the extensive number of codes, will require emphasized educating and good amount of practice.

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