Five Often-overlooked Benefits of the ICD-10 Transition

Many people focus on differences between ICD-9 and ICD-10 and the problems that ICD-10 may cause. However, there are many benefits of moving to ICD-10. Here are some of the biggest:

1. Reduced denials
Appropriate clinical documentation will be critical to selecting the correct diagnosis code in ICD-10. This more specific documentation will improve medical decision making, and it will ensure that the medical decision is supported by a clear picture of the encounter with the patient. This will reduce the amount of denials a practice encounters, thereby reducing the amount of time practice staff needs to spend addressing denials.

2. Time savings
ICD-10 has many combination codes used to classify two diagnoses, a diagnosis with an associated sign or symptom, or a diagnosis with an associated complication. The benefits of assigning one combination code versus separate codes is the use of fewer codes, therefore reducing the amount of time associated with using multiple codes. For example, when coding for pressure ulcers in ICD-9, two codes are required, one for the ulcer and one for the stage. In ICD-10, one combination code includes the site of the ulcer as well as the stage.

3. More opportunities to demonstrate need
In ICD-9, the codes for otitis media do not have an option for recurrent. ICD-10 has codes for acute, chronic, and recurrent, in addition to type and laterality. Using the recurrent code will show medical necessity and assist in getting approval for surgery.

4. Improved specificity
The preventive codes in ICD-10 include the specificity of “with” and “without” abnormal findings. Preventive services vs. acute visits can be clearly defined with the use of the new preventive codes in ICD-10. For example, a patient comes in for a well-child check and, during the exam, the provider discovers the patient has an ear infection. The provider treats the patient for the ear infection. The provider would code with abnormal findings and the otitis media. The provider codes for the preventive visit with an E&M visit with the 25 modifier.

5. More non-compliance codes
The non-compliance codes have been expanded in ICD-10. These codes protect physicians legally by documenting when patients are not taking their medication as prescribed or are not being compliant with their treatment. Reporting the non-compliance codes will help track and trend how many patients are not taking their medication correctly and why. For example, there is a code for non-compliance of medication regimen due to financial hardship. This may show a need to decrease the cost of prescriptions and a need for programs to help patients secure necessary medications.

Seeing the benefits in ICD-10 will help you and your staff members embrace and prepare for the upcoming transition.