ICD-10: No news is good news

Nov. 13, 2015 / By Rhonda Butler

It seems that wishes are not just for fairy tales, they can come true after all. So far, it looks like the wish for an uneventful ICD-10 transition is a reality. Even the month-end report from CMS was fabulously dull.

The bottom line is, coding issues are historically a tiny percentage of the total claim denials, and that is just as true for ICD-10 as for ICD-9. Historically, total claim denials run around 10% of total, and of those, 2% are due to incomplete or invalid information of any kind, including things like provider ID. Both the 10% and the 2% statistic remained stable across the transition to ICD-10.

The amazing thing is that historically only 0.17% of the total claims denied are for an invalid ICD-9 code. That is less than one tenth of the 2% mentioned above, claims denied for incomplete or invalid information of any kind. Wouldn’t you think it would make sense to work on the other 90% of that 2% rate instead of complaining about ICD-10? But I digress.

The truly amazing piece of news, the non-news that likely won’t get picked up by the mainstream media, is that the total claims denied for both ICD-9 and ICD-10 codes have actually been lower than the historical rate, down from 0.17% to 0.11% for ICD-9, and even lower for ICD-10, at 0.09%.

That was the 50,000 foot view of the ICD-10 transition—I also have fantastic but equally dull news to report from individuals out there in the trenches. I sit on the Editorial Advisory Board (EAB for short) of ICD-10 Coding Clinic, the American Hospital Association’s quarterly publication that issues coding advice for the industry.

Three members from the hospital provider community currently serving a term on the board are:

• Manager of documentation and data quality from a health system in California
• Director of clinical coding practice for a university hospital in New York
• Specialist in medical coding quality training and oversight for a major university hospital in Tennessee

They all report business as usual, and made a point of the fact that they don’t have a coding backlog because of ICD-10.

One of the three reported a couple of technical issues in the IT department that were quickly resolved that same day, but otherwise a quiet and smooth transition. Their coders were ready—the hospital in Tennessee had been training her coders in ICD-10 for four years. Wow, that is commitment.

Of course, this represents the best of the best, those who were dedicated to doing the transition right and made it happen. But they are not alone. The statistics from CMS make that pretty clear.

Like me, my colleagues on the board were relieved and happy that the transition so far has been a non-event. Let’s hope this excellent trend continues so that we can move on.

Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems.

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