ICD-10 Summary

How ICD-10 impacts the revenue cycle management by Sashi Padarthy discusses the “opportunity” for facilities to improve on “clinical documentation, revenue cycle performance, and analytic capabilities for business intelligence” (Padarthy, July 2012, p. 7). Padarthy suggests the shift from ICD-9-CM to ICD-10 will require multi-departmental assessments to determine core factors within ICD-10 will that will directly influence coding, billing and reimbursement.

Padarthy proposes facilities analyze their current diagnostic and procedural codes to assess whether their current codes accurately represent services provided. In addition, he asks facilities to determine “if an opportunity to leverage ICD-10” exists, and if so, what is needed; updated eligibility requirements, increased medical necessity

For example ICD-10 has expanded diagnoses codes from around 14,300 to around 69,000) and so the suggested need for a greater understanding of the logic and relationship affect between ICD-10 codes and current ICD-9-CM contracts and reimbursements means significant change to the status quo. In my experience is that change is feared or at least distrusted. So as I read the article the need for training to both reassure and build confidence seemed the key point. I think if providers can show staff system wide how use of ICD-10 codes will benefit the system and patient care, if the providers can fully integrate ICD-10 codes into the fabric of the organization then in time ICD-10 will become the familiar model to all (including insurers), just another part of daily work probably leading to that same mix of ambivalence. I think the trick is to do exactly what Padarthy suggests, to proactively and methodically integrate ICD-10 across the whole system in a measured and methodical way with due care to the impact on