South Florida Hospital News
Sunday June 13, 2021

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December 2011 - Volume 8 - Issue 6


How ICD-10 can be Advantageous to Providers

The shifting from ICD-9 to ICD-10 code sets will benefit the healthcare provider in the form of more accurate payments for new procedures, fewer rejected claims, fewer improper reimbursement claims and greater efficiency in the billing and reimbursement process.
The increased auto adjudication of claims due to increased granularity of ICD-10 code will help in reduced number of claims being investigated or rejected due to insufficient information. ICD-10 will solve the problems caused due to lack of detailed information contained in the diagnosis and procedure code assignment. Fewer rejected claims will reduce the amount of rework for providers leading to an efficient reimbursement process which in turn will lower the provider administrative costs.
A reduced claims cycle coupled with lowered administrative costs will help the providers shift the excess resources in improving patient care. ICD-10’s improved precision in documentation of clinical care will greatly improve the likelihood of submitting accurate claims the first time around and receiving reimbursement for a range of procedures. As a result, there is a reduction in adverse impacts to provider revenue cycle.
The ICD-9 code set has now been exhausted and new codes cannot be added which limits the ability to code innovative procedures. Treatment techniques and methods have evolved over time. The limitation on expanding ICD-9-CM is the reason why few new procedures have been approved. Not all advanced treatments can be coded using ICD-9 accurately. With ICD-10-PCS, the number of procedures for which new codes are likely to be granted will rise. If many more separate procedures can be coded, a differentiation between the simple and complex procedures will be possible.
The new code set helps in improved population identification and severity stratification due to ICD-10, and specificity enhances disease and case management, as well as wellness programs. Utilization management can be improved by application of ICD-10 codes which leads to increased efficiency in the exchange of patient profile information, treatments across the care process and hospital resource management.
Improved reimbursement rates due to appropriate payments of new procedures, and fewer miscoded and rejected claims due to greater specificity in ICD-10 codes. Accurate incentive payments for Pay for Performance schemes and in general accurate claims payment will help both providers and payers.
Providers with current or future contracts impacted by ICD-10 codes (which means many providers) would put themselves into a better negotiating position with payers by starting to use coding crosswalk tools and “double code” their services. They would then better understand the services they provide in an ICD-10 setting and negotiate more accurate contracts with their payers. I’m not suggesting all providers need to start double coding everything indefinitely – just start to sample and understand differences and potential differences between their current ICD-9 stats and the soon to arrive ICD-10 indications.
Considering some of the above suggestions for implementing and accepting ICD-10 changes can create a positive environment of change and acceptance of ICD-10. There are many advantages to the provider in payer contract negotiations if the provider is willing to take the time to implement an ICD-10 strategy now and begin educating themselves in ICD-10 coding and clinical documentation.
Ira Shapiro is the CEO of International Alliance Solutions, national experts offering ICD-10 and coding solutions for providers, and CODESMART UNIVERSITY™, an online ICD-10 education program for coders and clinicians, which will debut in January 2012. For more information, call (646) 526-7867 or visit
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