When in doubt, do the right thing

June 24, 2011
" When in doubt, do the right thing.  You'll be surprised.  You usually will know what the right thing to do is.  You'll also know why you don't
" When in doubt, do the right thing.
You'll be surprised. You usually will know what the right thing to do is.
You'll also know why you don't want to do it!
Do the right thing.
" --- Steven MullerThat was a bit of advise offered to my graduating class by my university president. Over the last several decades, the advice has rung all too true. Today, as I listened to presentations about ICD-10, given by CMS, a payer, provider-based HIM professionals, a CIO, a Gartner analyst, and others, I heard that ICD-10 is the right thing to do. The case is very compelling, and well documented by many. ICD-10 has been adopted by every other country on Earth. It can dramatically improve our ability to retrospectively understand the care that's been delivered relative to what's possible in ICD-9. To put things in perspective, ICD-10 has a quality identical to the Y2K situation we faced a decade ago. ICD-9 codes are embedded, nearly invisibly, in dozens of systems that are mission critical today. Interfaces are built with the expectation of ICD-9 formats, which are shorter and have different rules for padding and placement than ICD-10. Therefore, a comprehensive inventory of information systems is necessary as part of the planning process.
Why is ICD-10 different in the USA? Here is the conundrum. Although the rest of the world has successfully migrated to ICD-10, the U.S. will be the first country to go there. Why?
Because the U.S. healthcare system is unique, and the unspecified (or underspecified) payment reform inherent with converting to ICD-10 gives rise to economic issues which are not prominent elsewhere in the world.
The economics (complex payment systems) of healthcare delivery in the U.S. are integrally connected to ICD-9. These are unlike most, if not all other countries, that are using ICD-10. The result is there is no precedent to comfort or assure us that there will be no surprises. How can we avoid unexpected consequences to ensure that fair, reasonable, and equitable payments will occur for providers and payers after the conversion? The answer is to require careful monitoring, communications, and shared, explicit expectations. If you have any doubts about the multi-year process work to get to ICD-10, do your homework. Then, do the right thing. Thanks AHIMA (American Health Information Management Association) for a great ICD-10 Summit and Sue Bowan, RHIA, CCS, Director for Coding Policy & Compliance for this Resource/Reference List:
Resource/Reference List AHIMANational Center for Health Statistics ICD­10­CM Centers for Medicare and Medicaid Services ICD­10­PCS Final Regulations for ICD­10­CM/PCS Adoption and Modifications to Electronic Transaction Standards

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