ICD-10 codes are designed to help physicians make more informed treatment decisions and obtain better information to manage their patient population. Outsourcing ICD-10 coding to an experienced medical billing and coding company can ensure compliant reporting, and save healthcare providers overhead costs and valuable time. The much-touted benefits of ICD-10 codes include:

  • Improved diagnostic coding accuracy
  • Updated medical terminology and disease classifications
  • Support for payment models that reimburse physicians more for complex issues
  • Improved payment efficiency and prevention of errors
  • Provision of better data for the research purposes

Proper medical documentation is essential to good patient care, and communicating accurate and timely diagnoses is an important element of high-quality care. Diagnostic errors are a major threat to achieving high-quality care. However, according to a recent article in the Pulmonology Advisor, the use of ICD-10 codes can lead to diagnostic errors and payment reforms are needed to promote diagnostic accuracy. Based on a report published in Health Affairs, the article lists several concerns brought about by ICD-10 coding:

  • The value and utility of the granular ICD-10 codes greatly depends upon how accurately and effectively the classification system is used.
  • Improper use of ICD-10 codes in clinical practice may have exacerbated diagnostic errors.
  • The ICD-10-CM classification prevents clinicians from expressing “clinical concern” when there is insufficient, incomplete, or inconclusive evidence to support a firm diagnosis.
  • If a clinically relevant ICD-10 code is not pertinent for billing purposes, it is likely to be left out. Conversely, if a code is clinically irrelevant but is useful for billing, the coder may advise the physician to change the documentation and add the code.
  • The electronic medical record may prompt the physician to choose a code that may not correctly describe the patient’s condition.
  • Other ICD code-induced clinical workflow barriers include: expired code warnings, lack of coverage warnings, specificity prompts, retrospective prompts, and not being able to find the right code.

According to the report, today’s fee-for-service models aggravate these concerns by “tolerating, and in some cases, even encouraging diagnostic errors”. To get higher payment, physicians may use the bundled payment system and report a diagnosis requiring more extensive care than the patient needs.  Current payment models support higher turnover and as a result, the physician may not have time to think through diagnosis in complex cases or consult with peers on the matter. These models also encourage unneeded testing, and inappropriate testing and procedures, says the report.

These issues are in line with those listed by the Society to Improve Diagnosis in Medicine (SIDM) ACT for Better Diagnosis initiative. According to the Act, the six most common obstacles that impede diagnostic accuracy are:

Incomplete communication during care transitions, as there are chances that important information will slip through the cracks.

  • Lack of standardized measures/feedback for providers to understand their performance in the diagnostic process, to guide improvements, or to report errors.
  • Lack of timely, efficient support/resources for clinical reasoning
  • Restricted appointment times, which allows little opportunity to discuss further steps in the diagnostic process
  • Complicated diagnostic process – patients are not aware about the questions to ask, or whom to notify when changes in their condition occur, or what constitutes serious symptoms.
  • Lack of funding for research—the impact of inaccurate or delayed diagnoses on healthcare costs and patient harm has not been clearly expressed and there is a limited amount of published evidence to identify what improves the diagnostic process.

The Pulmonology Advisor article puts forward the following solutions to improve diagnostic accuracy:

  • Shifting to payment models that promote accountability for diagnostic performance
  • Separating clinical documentation from medical billing while ensuring that clinicians are rewarded for their time and services, and
  • Building expert opinion into the diagnostic process for patients with indefinable diagnoses.

Such reforms can improve the way insurance companies and government payers use ICD-10 codes to compare quality, cost, and estimations of resource use. To report ICD-10 codes that support the clinical documentation to promote good patient care and improved healthcare data, physicians can rely on an experienced medical coding service provider. Outsourcing companies that providing coding solutions also provide medical billing services to help practices protect their bottom line.