WEDI covers all the ICD-10 angles

'No one wants another delay. We are moving forward and we are moving forward together.'
By John Andrews
09:51 AM
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The WEDI Summer Forum on ICD-10 July 28-29 could be accurately referred to as "Everything You Ever Wanted to Know About ICD-10 (But Were Afraid to Ask)."

Over the course of two days, an assembly of providers, payers, vendors, government officials, consultants and association representatives covered as many aspects of ICD-10 as possible within the time allotted, placing the sharpest focus on the Oct. 1 deadline, provider readiness, claims adjudication, testing results and financial implications.

The sessions at the American Dental Association Conference Center were intimate, attended by approximately 100 people and featured "town hall" give-and-take comment interaction. This format produced a wide range of perspectives on all things ICD-10. Here's a rundown:

The dreaded deadline
While no one could say with certainty that the implementation date won't get pushed ahead yet again, the speakers were unanimous in arguing against it. Jim Daley and Laura Darst, WEDI ICD-10 workgroup co-chairs, laid it out plainly: "Oct. 1 is four years more than the original proposed date and more than six-and-a-half years from the original final rule publication. The estimated one-year delay costs between $1.1 billion and 6.8 billion dollars."

Penny Osmon Bahr, director of Avastone Health Solutions, generated a lot of head nods by saying, "No one wants another delay. We are moving forward and we are moving forward together."

At the same time, Randi Upham, partner and vice president of Provider Practice at FluidEDGE Consulting, wondered aloud "Does anyone believe another delay will happen? Because every time I've gone on record saying I don't think it will be delayed, it was delayed every time."

Code confusion
In reviewing the joint CMS-American Medical Association announcement of July 6, attendees discussed at length a statement about "claims billed under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis code will not be denied as long as the physician/practitioner used a valid code from the right family."

While to some the language is clear, others expressed confusion and concern, especially about the definitions of "specificity" and "family."

Joe Nichols, principal with Health Data Consulting, observed that "a lot is misunderstood about specificity." The announcement has caused varying interpretations that raises more questions, Nichols said, such as "'Does it mean we have another year? Can ICD-9 codes be as good as ICD-10?' The claims won't be denied solely on specificity alone. The bottom line is that this doesn't change anything."

'Specificity' clarified
To quell physician anxiety about "specificity" and finding the right "family" of diagnosis codes, Stacy Shagena, technical advisor for CMS, insisted that the agency is "not looking for diagnosis errors. The family of codes confusion is explaining what we meant – first you must have a valid code and that definition hasn't changed. It's the same one used in acknowledgement testing. You would not fail an audit or post-pay review."

Steven Benjamin, program director of ICD-10 at United Healthcare, pointed out that "there is specificity with 9" and that "the new things with 10 are only necessary when there is limitation of the code set. We don't have metrics that will deny the claim because the wrong one was chosen."

Paybacks are swell
Keeping an eye on the financial prize, the University of Mississippi Medical Center endured "an arduous process" in facilitating "major mentality shifts" among the physicians, says John Showalter, MD, chief health information officer.

"We want to improve documentation in the patient's health record," he said. "Focus on what you're writing down and we want it to be sustainable over the years."

Initial results show a 1,000 percent return on investment as "$1 million has generated $10 million in revenue already."