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INTEGRATING ICD-10 IN YOUR PRACTICE
payment system based on quality and outcomes. Continued
use of an outdated and broken coding system erodes data
quality and, thus, has an adverse effect on the value of
health care data, including an increased risk for inaccurate
health care decisions based on faulty and imprecise data.
The ability to accurately analyze health care services provided
to patients and whether care is fairly reimbursed is
compromised.
Continued use of ICD-9-CM results in costs associated
with:
• Inaccurate decisions or conclusions based on faulty or
imprecise data
• Administrative ineffıciencies because of reliance on
manual processes
• Coding errors related to code ambiguity and outdated
terminology
• Worsening imprecision in the ICD-9-CM code set because
of the inability of the code structure to adequately
accommodate desired modifıcations 4
OPPORTUNITIES FOR LEVERAGING ICD-10 TO
IMPROVE CARE AND REDUCE COSTS
The transition to ICD-10-CM and ICD-10-PCS (collectively
referred to as “ICD-10”) presents an opportunity to greatly
improve the capture of information about the increasingly
complex delivery of health care, leading to improvements in
health care delivery and operations, better patient outcomes,
and reduced health care costs. ICD-10 is the next-generation
coding system that will modernize and expand the capacity of
health care organizations to keep pace with changes in medical
practice and health care delivery by providing higherquality
information for measuring service quality, outcomes,
safety, and effıciency. The granular level of detail in ICD-10
codes is expected to generate more precise and clinically accurate
characterizations of patient diagnoses, which in turn
will lead to a more accurate reflection of patient conditions.
The improved structural flexibility will allow for the addition
of new diseases or expanded detail in the future.
Measures of health care are only meaningful if the data
used to defıne conditions and services accurately represent
the reality of care. 5 Increased precision in ICD-10 will lead to
better quality measures. Better and more effective quality
measures will translate to better care that will ultimately benefıt
consumers. The additional detail in ICD-10 will affect analytic
tools, reports, and comparative data used by all quality
measurement systems, including quality indicators from The
Joint Commission, CMS, and the Agency for Healthcare Research
and Quality, as well as clinical registries and state reporting
systems.
By allowing for greater coding accuracy and specifıcity,
ICD-10 is key to collecting the information needed to implement
health care delivery innovations such as patientcentered
medical homes and value-based purchasing. The
investments that are being made in accountable care organizations
(ACOs), meaningful use EHRs, and value-based purchasing
are all predicated on having a more precise and
comprehensive code set that is up to date with the rapid changes
in practices and technologies utilized in today’s health care system.
ICD-10 will enable better patient care through better understanding
of the value of new procedures, improved disease
management, and an improved ability to study and understand
patient outcomes, yielding benefıts to patients far beyond cost
savings. Better understanding of diseases and injuries will lead
to improved prevention or mitigation strategies. Clinically robust
algorithms to treat chronic diseases and track outcomes of
care can be designed.
New models of health care payment and patient management,
such as ACOs, bundled payments for episodes of care,
pay for outcomes, risk sharing for total costs of care, and
patient-centered medical homes will create increased demand
for detailed, high-quality data. Accurate, detailed
health care data will be needed to construct risk analyses and
predictive models that allow rational risk sharing. Patient
populations need to be defıned, care paths assessed, and care
outcomes understood much more clearly and deeply than
they are today if payers, employers, and providers are to negotiate
as equals. Additionally, information that drives regional
or national health care policies relies on intelligence
derived from coded data. Decisions are only as good as the
information those decisions are based on. Better data will
translate to better decisions. 5
EHRs and interoperability require a modern code set for
summarizing and reporting data. Without ICD-10, the U.S.
investments in EHRs is greatly diminished, as the value of
more comprehensive and detailed health information is lost
if it is aggregated into outdated, broad, ambiguous codes. The
health care industry has struggled to defıne health information
standards that will allow true interoperability and the
ability to analyze “big data” across enterprises. 5 ICD-10 is
needed to exchange meaningful data. Also, many public and
national health information systems, reporting programs,
and data sets rely on accurate and timely diagnosis codes to
classify and track disease morbidity and mortality, quality of
care, and health disparities, and monitor public health
threats. Use of ICD-10 will standardize the reporting of public
health data (including disease outbreaks and bioterrorism
events) across the globe, achieve international health data
comparability, and enable international comparisons of
quality of care and sharing of best practices among countries.
Since ICD-10 has been used for mortality reporting in the
United States since 1999, the implementation of ICD-10 for
morbidity reporting would achieve comparability between
mortality and morbidity data, resulting in enhanced data for
improving community health and administrative cost savings.
In many states, mortality data are cross-analyzed with
hospital data to develop intervention strategies. Resources
are being wasted to convert mortality data back to ICD-
9-CM to correlate with hospital data.
Anticipated benefıts of using more robust, up-to-date code
sets can be identifıed in the following areas 6 :
asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK
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