ICD-10: Erro ou algo de Y2K de cuidado de saúde mais sério?

May 23, 2011
From the May 2011 issue of HealthCare Business News magazine
This report originally appeared in the May 2011 issue of DOTmed Business News

By Isam Habboush

Health care in the United States is entering a new era of accountability. Health systems are under pressure to optimize clinical documentation practices to align reimbursement with delivered care and clinical outcomes. The impending migration to ICD-10 in 2013 is one manifestation of the expanding complexity of government and private payers’ clinical documentation rules and regulations.

The impact of the transition to ICD-10 is widely expected to be invasive, costly and challenging and is frequently described as the “Y2K bug” of the health care IT industry. The Y2K bug had a huge impact on the banking and financial industries, requiring expensive upgrades to most infrastructure systems. Most people probably still remember the worldwide anxiety as the minutes ticked away towards that one particular midnight over a decade ago. Fortunately, disaster did not strike.

The transition to ICD-10 is likely to be highly disruptive to the U.S. health care system, if not managed carefully using the right mix of tools, training and processes.

While the Y2K bug forced organizations to upgrade systems with software that could handle two extra digits in the year format, there were little changes to processes, training or work habits. In contrast, ICD-10 will require not only expensive upgrades, but also modifications throughout the entire clinical documentation, coding and billing value chain.

The challenges of ICD-10
Organizations will have to train health information management, clinical document improvement, case management, billing, quality and auditing staff on ICD-10 to ensure coding is performed correctly, and accurately reflects clinical information. Industry experts suggest the steep learning curve associated with the new coding standard may cause as much as a 50 percent initial drop in the productivity of medical coders, even after all the tools and systems are upgraded.

Most importantly, physicians will need special training to document with the additional specificity required by ICD-10. For example, documenting the phrase, chronic heart failure will no longer be sufficient. With ICD-10, physicians must also specify systolic, diastolic or both, and the acuity level. Similarly, instead of respiratory distress, physicians must explicitly state acuity level. These are just simple examples - real-life documentation needs are even more complex.

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