News: ICD-10 coding not reaching full potential, experts say

Although the transition to ICD-10-CM/PCS was fairly smooth, two years later billing and coding experts say that, in most cases, the codes are not being put to their intended use.

The October 2015 transition from the ICD-9 code set (with about 14,000 codes) to the ICD-10 set (with more than 69,000) was fraught with concerns about a potential landslide of claim denials for practices that weren’t prepared. To deal with the anticipated chaos, CDI professionals also saw a rise in jobs and programs during this time.

For the most part, however, the concerns never materialized.

“In the end, it wasn’t a big deal,” says Deborah Hill, a managing consultant with the Coker Group in Alpharetta, Georgia, and the transition quickly segued into business as usual.

But, that’s not necessarily good news, Hill adds.

“Many practices simply created a new set of shortcuts to replace the old set of shortcuts” instead of learning the proper way to use the ICD-10 codes, says Hill. “If everyone were doing this 100% accurately, it would have been a much bigger deal than it is. But providers are just finding new shortcuts and doing just enough to stay under the radar.”

A conscientious CDI team, though, can help the providers and facilities use the ICD-10-CM/PCS code set to its fullest potential bridging the gap between those increased opportunities for greater specificity and the actual documentation physicians use in the record.

Editor’s note: This article was originally published in Physician Practice Perspectives. Subscribers can read the full article in the July 2017 issue.