The scope of Billing & Coding Specialist is expanding greatly with ICD-10, the tenth and latest upgrade of the International Classification of Diseases and Related Health Problems (ICD), a list created by the World Health Organization (WHO).
While chance is always challenging, it brings forth a fresh set of benefits, opportunities and difficulties. Let’s take a quick look at 4 major advantages and 3 major disadvantages of ICD-10:
- Better Patient Care: The first benefit is the most obvious. Patient care is the primary purpose of any improvisation in healthcare management. ICD-10 greatly increases the level of detail, leading to higher ability in measuring quality and safety of healthcare. The detailed data analytics will help healthcare practitioners, healthcare managers, and healthcare administrators & policymakers; in creating better standards, efficient structures and procedures, lowering risks, and better policies.
- Better Research: The better detailing data management with deeper data analytics will enable healthcare practitioners and researchers to find better cures and procedures. ICD-10 will provide space for accommodating advancement in medical techniques; something that the saturated ICD-9 no longer provides for. The expanded codes will allow finer correlation of medical conditions with their cause, treatment and final result.
- Better Resource Utilization: ICD-10 provides healthcare administrators the data to determine the time and resources spent on treating a medical condition. This provides them with better decision making tools for more judicious resource allocation and achieves better clinical outcomes without compromising on the quality of healthcare.
- Better Claims Processing: Higher detailing in data along with inclusion of newer and advanced medical procedures, makes ICD-10 a claims-friendly code. The improved availability of specific data will reduce denial of claims and the time required for processing claims.
- New Training: The number of codes in ICD-10 is 150,000; while ICD-9 had 18,000 codes. This is a vast expansion. Earlier the doctor could notate something general, for instance “Pain in the Limb.” Now, the doctor needs to notate very specifically, including the area of pain in the limb, whether it’s the left or the right limb etc. Both the doctor and the billing & coding specialist will require new training programs to cope with ICD-10 requirements, otherwise the doctor / healthcare institution may lose out on billing.
- Slowdown during The Transition: The transition to ICD-10 will lead to slowdown, at least in the transition period which could last for a while. This slowdown can be due to two reasons. The first one is training, which will require extra time to be invested. The second reason is that execution will require new degree of meticulousness as well as back-referring to the books, which will temporarily slow down the productivity.
- Reimbursement Uncertainties in Initial Period: While it has been proclaimed that there will be no variation in payout, the new coding structure might lead to lower billings in the initial period. This could be due to lack of complete understanding of how the new coding system works and doctors might miss out on important notations which eventually lead to lower payouts.
As we can note, ICD-10 comes across as a mixed bag for the healthcare industry. However, most of its challenges are temporary. The benefits are long-term and have the potential to evolve healthcare to the next level.