Like everyone, I’ve watched the back-and-forth comments on ICD -10. I know the AMA is still in opposition, but I really was quite amazed when I read the Medical Group Management (MGMA) study that tries to help explain one of the AMA’s reasons for opposition. MGMA did a study of ICD-10 preparedness among medical practices. Apparently the survey found a surprisingly high number of medical practices that rely on “unspecified” ICD-9 codes. In my opinion, that is unfortunate—no one should be using or paying for unspecified codes unless it is a new procedure or treatment that does not have a code to represent it yet. The pundit writing about the survey opined that “unspecified” will not work well in ICD-10, and this is one of the reasons why physicians are struggling. I beg to differ. Regardless of how specific the language is, there are still 22,728 ICD-10-CM diagnosis codes that contain “unspecified” in the code descriptor. So for those not clear on what they’re doing in ICD 9, fear not: there will still be plenty of unspecified codes in ICD-10!
Honestly, I am getting a bit frustrated with the talk and excuses of why the language is too expensive/won’t/can’t possibly/isn’t working. There must be some entities focused on moving forward other than the American Hospital Association (AHA) and the Blue Cross and Blue Shield Association. Is anyone out there working in ICD 10? Perhaps they are too busy using the language to write about it. Perhaps the professional organizations should focus on helping physician practices code accurately (even in ICD-9) rather than criticizing a language that will actually assist their members in the future. Using specific ICD-9 codes will help them choose even more specific ICD-10 codes.
Full disclosure: since 2010, I have been a part of the team working on the translation of the CMS National Coverage Determination (NCD) medical necessity policies from ICD-9 to ICD-10. Like any new adventure, we began with a bit of trepidation, but we looked at the task rationally and created a work plan. We converted the existing ICD-9 code lists in the policies to ICD-10 using the GEMs as the starting point. Each code translation was reviewed to be certain the output of the GEMs suggestions, while matching from a code perspective, also represented the core logic of the policies we were working on. We removed many mappings based on policy logic, but in my experience, the GEMs are very accurate when mapping ICD-10 to ICD-9. They are an invaluable, free tool (thank you, CMS) that everyone should be using. It was amazing to see a relatively vague ICD-9 code emerge in ICD-10.
Specificity is better—just wait until you become accustomed to it. It’s like the difference between generic chocolate and high-end, imported, organic, 70% cacao (you get the picture) dark chocolate. Diagnostic specificity actually helps support greater-than-usual professional effort, which can help quantify use of some modifiers on CPT codes. Any clinical specialty working on specific body parts should be rejoicing. Soon they will have access to codes that accurately represent their work. Those clinicians treating patients with multiple chronic diseases finally have a way of communicating all co-morbidities which clearly describe the acuity of their patient mix. Remember, use this data at payer contracting time to negotiate higher rates—a task all but impossible using generic “unspecified” codes.
The industry will most certainly survive the transition. An important first step is to jettison fear and anxiety and approach ICD-10 rationally. Use the GEMs, do some mapping, and practice translations. Now, when I read something, I can immediately see how it can be expressed in ICD-10 so much more accurately than is possible in ICD-9.
P.S. If you have ever wondered if CMS cares about the administrative challenges providers face, I want to assure you those in Coverage (at CMS) take the translation process very seriously. They are working assiduously to be certain the purpose of each NCD is not altered during the translation process. They care.
Barbara Aubry is a Regulatory Analyst for 3M Health Information Systems.