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INTEGRATING ICD-10 IN YOUR PRACTICE
ICD-10 recognizes distinctions in clinical conditions and severity
that can help segment patient populations within a disease
category. ICD-10 offers opportunities for improved,
automated identifıcation, stratifıcation, and segmentation of
patient populations. With greater code specifıcity, better algorithms
can be developed to identify and target-specifıc
patient populations and subpopulations for disease management
programs and customize programs for patients with
differences in severity or risk. Target groups’ progress toward
goals and effectiveness of treatment can be monitored
through the clinical and severity distinctions in ICD-10
codes. As more ICD-10 data is collected and additional
ICD-10 experience is gained, prediction models can be
greatly enhanced to more accurately predict risk within populations
by a number of refıned parameters. Superior data
will improve the ability to evaluate the effectiveness of disease
management programs in improving patient outcomes, reducing
the incidence of acute episodes, and decreasing health
care costs.
Ultimately benefıting patients, better data will support:
• Improvements in patient outcomes and patient safety
through better data for analysis and research
• Improved ability to manage chronic diseases by better
capturing patient populations
• More accurate reflection of patients’ clinical complexity
and severity of illness
• Improved ability to identify high-risk patients who require
more intensive resources
• Improved ability to manage population health
• Improved information sharing, which can enhance
treatment accuracy and improve care coordination
• Improved ability to assess effectiveness and safety of new
medical technology
• Improved diagnosis of chronic illness and identifıcation
of underlying causes, complications of diseases, and conditions
that contribute to disease complexity
• More accurate reflection of clinical complexity and severity
of illness
• Increased patient engagement
Complete and accurate data must be reported to put the
most appropriate picture of the quality of care delivery in
front of increasingly sophisticated and informed potential
patients. With better data will come an expanded ability to
educate consumers on costs and outcomes of treatment options.
Increased patient understanding and involvement in
their health care will improve the population’s health and decrease
the cost of health care.
ICD-10 BENEFITS FOR CLINICIANS
The transition to ICD-10 also benefıts clinicians. Compared
with ICD-9-CM, medical terminology and classifıcation of
diseases are more consistent with current clinical practice
and medical knowledge (e.g., newly recognized conditions
are identifıed and conditions with a recently discovered etiology
have been reclassifıed). Many physician specialty societies
have actively contributed to the clinical content of ICD-
10-CM/PCS and continue to be involved in the annual
updating process to ensure the code sets represent current
clinical knowledge. The increased specifıcity will provide better
justifıcation of medical necessity for treatment and diagnostic
tests. Exchange of patients’ clinical information will be
more effıcient. Better data on patients’ clinical conditions will
help to validate reported evaluation and management codes
and result in less misinterpretation by auditors, attorneys,
other third parties. More detailed data facilitates the informed
use of both business intelligence and clinical dashboards.
Business intelligence dashboards make performance
and trend data more readily available and, thus, facilitate attainment
of meaningful use criteria. Clinical dashboards
have the potential to drive better care paths and achieve better
clinical outcomes.
The increased granularity of ICD-10 will enable more directed
clinical decision support. When a patient has multiple
medical conditions or manifestations of a condition, the failure
of clinical decision support to take into account all of the
patient’s clinical factors can result in: (1) lack of oversight or
specifıc monitoring of manifestations and (2) medication
protocols and their effect on the patient during and after
treatment. The ability to fully leverage clinical decision support
tools will help direct clinician monitoring to avoid complications
or adverse drug events.
In an accountable care environment, providers need to assume
an essential role in determining and prioritizing those
services that offer the greatest benefıt in the context of fınancial
constraints. Models that allow providers who are part of
integrated delivery systems to take on the risk of care delivery
and share the rewards of high-quality, effıcient care are continuing
to evolve. The ability of ICD-10 to provide better detail
to defıne risk, severity, anatomic detail, comorbidities,
complications, disease phases, sequelae, and other key parameters
of the patient’s health state will be critically important
in effectively managing patients and benefıting from
effıcient care delivery. 5
The move to ICD-10 will also lead to increased administrative
effıciencies and, thus, lower administrative costs. These
reduced administrative costs come from improved coding
accuracy and productivity, fewer pended or denied reimbursement
claims because of more information provided by
the submitted codes, and fewer payer requests for submission
of supporting medical record documentation (because of
more detailed information provided by the codes). The increased
specifıcity, representation of current clinical knowledge,
and use of more up-to-date medical terminology will
make ICD-10 codes easier to assign than ICD-9-CM codes.
In the long-term, after the learning curve has ended, it is expected
that the use of ICD-10 will result in fewer coding errors
than ICD-9-CM because ICD-10 is less ambiguous and
more logically organized. The ambiguity in ICD-9-CM and
use of outdated terminology that does not correspond to
terms used in clinical documentation makes ICD-9-CM confusing,
diffıcult to use, and open to misinterpretation. The
increased specifıcity in ICD-10 will also facilitate the development
of more sophisticated automated coding tools to as-
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