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More ICD-10 Myths

April 1, 2021
April 1, 2021

By Tom Ormondroyd, Vice President/General Manager, Precyse Learning Solutions

Here is a continuation of some common ICD-10 myths, from my previous blog quoted in Dispelling Some Myths About ICD-10. These are common ICD-10 myths that continue to plague all of our efforts to obtain buy-in and motivate our impacted populations to want to learn more about and prepare for the transition. Some of these myths are just nuisances, while others are true showstoppers that undermine the efforts of our industry.

Myth #1: Physicians who choose their own codes will not have to worry about training as their EMR will do this for them.

Truth: Although EMRs are starting to do some great things in regards to prompts, problem lists, and other assistive tools for ICD-10, they do not take the place of required education for those physicians selecting their own codes. One of the biggest concerns with ICD-10 is driving accurate representation of the severity of our patients’ illnesses and hence, the medical necessity of the procedures and tests we will perform. If a secondary condition is not on our problem list or we do not have quick access to more specific code choices, the physician may miss out on opportunities to capture this greater specificity and severity of illness leading to possible greater scrutiny. Documentation education is also key because if we do not have the documentation to support the code selected, then we open ourselves up to significant risk. EMRs are a vital aspect of our transition to ICD-10, but understanding of the core concepts of ICD-10 physician documentation and coding are required to be successful. 

Myth #2: ICD-10-CM is a reimbursement system, not built for clinicians.

Truth: With all of the debate currently going on about ICD-10, one of the key aspects of ICD-10 that is often forgotten is the creation and development of ICD-10. The system itself started its origins at the WHO through the efforts of a team of physicians, clinicians, coders, and other healthcare professionals and then further modified by the United States again by a team of clinicians and other healthcare professionals. The system is far more rooted in current clinical though and practice than the ICD-9 system, but has not been able to shed its coding-only, reimbursement-only type moniker. 

Take one example of how it is more clinically focused: Hemorrhoids. Today, a physician lacks the ability to show the true severity of a patient’s hemorrhoid. There are very few choices in ICD-9 and most end up being classified as simply external or internal. No matter how severe the case, we often need to choose from these limited choices. In ICD-10-CM however, hemorrhoid codes are structured clinically, the opposite of the myth. With ICD-10-CM, we will be able to choose the grade/degree of the severity from first to fourth. As we all know, more severe cases of conditions take longer to diagnose and treat. Today in ICD-9 for this example, we have no way to show why we spent as many goods and services as we do, but ICD-10-CM offers the opportunity. Interestingly, ICD-10 does not do this with just more code choices (in fact, there are less ICD-10 codes for hemorrhoids), but instead, just better and more clinically-relevant ones. 

This is only one example, but one we must communicate to ensure the clinical nature of the system is understood.