As you’re coming down from all of the Halloween hoopla, “scary” may be the last word you want to hear. But the results of the recently completed ICD-10 test pilot program are just that.
Speaking before hundreds of attendees at this year’s HIMSS conference, Holt Anderson, Executive Director at the North Carolina Healthcare Information and Communications Alliance, said providers in the program reported a startling 50% decrease in worker productivity and a higher rate of errors when submitting claims.
Let’s review the outcomes of the ICD-10 pilot program and the areas projected to cause the most trouble.
ICD-10 Pilot Program Results
The test launch, which ran between April and August, consisted of 30 provider organizations including software system vendors, health plans, billing companies, claims clearinghouses and government contractors.
The final 54-page report from HIMSS and the Workgroup for Electronic Data Interchange revealed that medical coders participating in the ICD-10 coding pilot produced accurate codes less than two-thirds of the time. In addition, it took coders twice as long to submit a claim using ICD-10 than it did in the ICD-9 coding system.
Accuracy rates also varied depending on the type of medical condition coded. For instance, an assessment of acute gastritis without bleeding was coded accurately on 100% of claims, but “chest pain, unspecified” was coded accurately only 34% of the time.
Lisa Gallagher, Vice President of Technology Solutions at HIMSS, says these disparities will be common in such a highly specified system.
“There are all kinds of supporting functions that end up influencing how a document is coded,” said Gallagher. With ICD-10, “you’re moving to a place where there is so much specificity in how things are coded. They may not know they need to provide documentation to a coder to reach a certain granularity.”
Gallagher said the main takeaway from the pilot should be that the healthcare industry needs to work together to meet ICD-10 issues head-on.
Lessons Learned
Because coding errors were so prevalent, the study lists certain mistakes that occurred regularly.
Some of the common mistakes revealed from the pilot study included:
- Coders often confused the number “0” (zero) with the letter “O” and the number “1” (one) with the letter “l.”
- On occasion, coders coded the diagnosis but forgot to code the procedures.
- Most errors were functional, including records coded incompletely or codes associated with the wrong medical test.
- Some coders forgot to specify the specific type of chest pains, not looking at the information in the medical record that differentiated them from atypical pains.
- Coders relied too much on their coding software instead of referencing codebooks.
Let’s face it. For those worried about ICD-10, these pilot program results definitely don’t quell any concerns. As always, we recommend providers start taking the necessary steps now to prepare for the immense change set to start on October 1, 2014.
