In what ways do you think ICD-10 could hurt providers and patients?

[Laureen]

This article stimulated my thinking about this - what do you think?
http://www.healthcarefinancenews.com/news/9-ways-icd-10-could-hurt-providers-and-patients

ICD-10 Impact on providers
1. Updating legacy computer systems.
2. New certification criteria.
4. Dual-entry procedures during transition period.
5. Loss of productivity.

ICD-10 Impact on patients
1. Inaccurate diagnoses resulting from test ordering.
2. Increased specificity could lead to increased reliance on erroneous data.
3. Denial of benefits resulting from inaccurate coding.
4. Diagnosis codes must match treatment codes to guarantee insurance coverage.

 

[Danielle]

I can think of the new code in ICD-10-CM that will state that the patient has mistaken the pharmaceuticals due to inability to pay. During my ICD-10-CM bootcamp we discussed how this will affect patients getting treatment but could also help the insurance companies to see that patients can not afford their medications. This code could be bad and good for patients

How it could hurt the patient: The patient is prescribed medicine for a diagnosis and told to take 2 pills per day, the patient has a 6 month supply but, has a hard time paying for the medication. The medication prescribed to the patient is not covered by insurance. Because of the inability to pay, the patient cuts the pills in half making them last longer. Something goes wrong with the patient landing the patient in the hospital and according to our records we coded that they misused their prescriptions due to inability to pay, the insurance company may say they refuse to pay for treatment because it was self-induced problem.(if the patient took the pills as prescribed hospital could have been prevented)

How it could help the patient: the insurance company sees a need to offer coverage on the medication the patient needs

 

[Laureen]

Nice comment. I never thought of that with the medication coverage. I don't recall the codes for inability to pay being in ICD-10 - now I'm going to have to go find it. Off to findacode.com ;-)

 

[Danielle]

it is code Z91.120 patients intentional underdosing of medication regimen due to financial hardship
also code Y63.6 is underdosing and non administration of necessary drug, medication or biological substance

 

[Laureen]

Thanks for looking that up. ICD-10 is going to be fun for sure - I actually like it better. The concept of each slot having a meaning just makes more sense to me.

 

[Danielle]

ICD-10-CM is going to be so much fun I think too
maybe just for coders though
I thought of a way it will impact physicians
their documentation needs to be beefed up to be more specific on location, laterality, and more
Coders are going to need to if not already develop a good relationship with the doc and help them to get their documentation up to par. Doctors don't like charting now they are really not going to like ICD-10-CM
*I know of a doctor that only uses unspecified codes now because he does not want to spend time documenting, when ICD-10-CM comes out he will no longer be paid for unspecified codes*(this came from the AAPC ICD-10-CM bootcamp)