Helping Physicians Succeed in an ICD-10 World: White Paper

April 1, 2021
April 1, 2021

As the healthcare industry draws closer to the go-live date, ICD-10 remains a polarizing topic among healthcare professionals. While some healthcare organizations are actively preparing for a strategic rollout, others are, more or less, bracing for impact. In April 2012, the Centers for Medicaid & Medicare Services (CMS) extended the ICD-10 (the International Classification of Diseases, tenth revision) implementation deadline to October 1, 2014 at the request of some physicians, hospitals, and other industry stakeholders. Since then, the American Medical Association (AMA), in partnership with other groups, has urged CMS to eliminate ICD- 10 implementation altogether due to the significant administrative and financial burden it imposes on physicians. There is no sign this will happen, however, or indication of any further postponement. In fact, the acting CMS Administrator, Marilyn Tavenner, has recently stated, “Many in the health industry are under way with the necessary system changes to transition from ICD-9 to ICD-10. Halting this progress midstream would be costly, burdensome, and would eliminate the impending benefits of these investments.”

ICD-10 Complements Our More Advanced Healthcare System

There are many differing opinions concerning the transition to ICD-10. But, in reality, ICD-10 is necessary to all levels of a technologically progressive healthcare system. Given the magnitude of change happening in the U.S. healthcare delivery system, ICD-10 is a natural and necessary advancement that will address the critical gaps and operating flaws inherent in ICD-9, which was developed over 30 years ago. Since then, healthcare science and technology have greatly advanced, making ICD-9 inadequate to deal with the advances in healthcare. Moreover, the content of the ICD-9 Clinical Modification (CM) was not designed to be used as a data system for disease management, nor was it intended to support reimbursement of medical services. ICD-9 is an antiquated classification that has a puzzling mixture of code descriptions—some very specific, and others that are so broad they fail to even identify the site of the disorder. Today, we have a system that does not always fully capture the severity of our patients’ illnesses, which prevents physicians from receiving full credit for the care performed in quality reporting.

Implementing ICD-10 is a Physician Challenge. Focusing on ICD-10’s Benefits is Important.

To be sure, implementing ICD-10 is a major undertaking for all healthcare professionals, who are faced with many other challenges, including meeting the requirements of Meaningful Use legislation. ICD- 10 compels greater specificity in documentation practices; it also involves a new coding classification system and an increase from 17,000 to more than 140,000 codes. It is estimated that ICD-10 implementation costs will range between $83,000 and $2.7 million, depending on the healthcare organization or physician practice size, according to the AMA. The Advisory Board Company calculates that the three-year incremental impact of ICD-10 could range from $2.5 to $7.1 million for a typical 250-bed hospital, with coder productivity decreasing by close to 20% and physician productivity taking a 10% to 20% hit due to significant increases in queries.

This white paper includes: 

  • Clinical Roots: How Physicians Shaped ICD-10
  • Why Physicians Should Care About ICD-10
  • How ICD-10 Data Will Benefit Physicians
  • What’s the Physician Return on Investment (ROI) for ICD-10?
  • Case Study: Applying ICD-10 to Crohn’s Disease
  • A Guide to Taking Control of ICD-10
  • A List of Major ICD-10 Documentation Changes