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The Transition to ICD-10-CM/PCS: a Comparison of Physician and Coder Perceptions

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The Transition to ICD-10-CM/PCS: a Comparison of Physician and Coder Perceptions The Transition to ICD-10-CM/PCS: A Comparison of Physician and Coder Perceptions THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Jennifer A. Butz Graduate Program in Allied Medical Professions The Ohio State University 2015 Master's Examination Committee: Dr. Emily S. Patterson, Ph.D., Advisor Dr. Laurie Rinehart-Thompson, JD, RHIA Dr. Amanda Agnew, Ph.D. Copyright by Jennifer A. Butz 2015 Abstract Background: The United States (U.S.) has used ICD-9-CM/PCS to capture descriptive data about diseases and procedures since the late 1970s. Although the World Health Organization (WHO) released ICD-10 in 1990, the U.S. has yet to transition to the more detailed and descriptive system and in 2017, the WHO will release ICD-11. While the limitations of ICD-9 are well documented and recognized throughout the healthcare industry, the transition to ICD-10 continues to be delayed. The transition to ICD-10 has become a highly polarized debate in which industry leaders are focusing their efforts in lobbying for either a timely implementation of ICD-10 or else additional delays. Design and Methods: A secure online survey was distributed to physicians and coders; the survey included questions about the perception of the upcoming transition to ICD-10, how the transition would likely affect their workload, and socio-demographic questions. The coder survey was distributed October 2014 through February 2015 via the Ohio Health Information Management Association (OHIMA) October 2014 newsletter, the OHIMA 2014 Fall Seminar, and the American Health Information Management Association (AHIMA) Coding, Classification, and Reimbursement Online Community. The physician survey was distributed in September 2014 to the Association of Medical Directors of Information Systems (AMDIS) listserv. The nonparametric Mann-Whitney U Test was used to determine if the difference was statistically significant for questions that were hypothesized a priori to be different between the two groups of respondents. Results: While the majority of coders and physicians agreed that ICD-9 should be replaced, as hypothesized, there was a statistically significant difference between coder and physician responses when asked if ICD-10 should be delayed again and if U.S. should skip ICD-10 and wait to implement ICD-11. Physicians agreed more with both statements than coders. Additionally, the majority of physicians preferred a simpler coding and documentation system than ICD-10, while coders preferred more detail and integration. Finally, both physicians and coders expected an increase in the amount of interactions between the two groups with the implementation of ICD-10. Conclusion: Physicians expressed a stronger desire to delay the implementation of ICD- 10 than coders. On the other hand, further postponement of ICD-10 or waiting until ICD- 11 to transition are not realistic objectives. The data provided by ICD-9 is not descriptive enough to support the evolving healthcare industry and the U.S. cannot wait for the version of ICD-11 which would adequately support billing requirements. The amount of detail in documentation is the primary concern among both physicians and coders with ICD-10. Physicians are concerned about the time the additional detail in documentation ii will take away from patient care, while coders are concerned that provider documentation will not provide enough detail to support justified ICD-10 codes. iii Dedication This thesis is dedicated to my parents, for supporting me in every way possible since the day I was born. iv Acknowledgments This thesis acknowledges my advisor, Emily Patterson, who provided me with endless encouragement and guidance throughout the process of writing my thesis. Emily continuously challenged my thinking and for that, I am thankful. I would also like to acknowledge Laurie Rinehart-Thompson, Melanie Brodnik, Susan White, and Anne Casto. All of whom have had a profound impact on my education and without one of them I would not be where I am today. v Vita May 2009 .......................................................Hilliard Davidson High School 2013................................................................B.S. HIMS, Ohio State University Fields of Study Major Field: Allied Medical Professions vi Table of Contents Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iv Acknowledgments............................................................................................................... v Vita ..................................................................................................................................... vi Fields of Study ................................................................................................................... vi List of Tables ..................................................................................................................... ix List of Figures .................................................................................................................... xi Chapter 1: Statement of the Problem ................................................................................. 1 Chapter 2: Literature Review .............................................................................................. 7 Chapter 3: Methods ........................................................................................................... 13 Chapter 4- Research Results ............................................................................................. 18 Chapter 5- Summary, Conclusions, and Recommendations ............................................. 47 Bibliography ..................................................................................................................... 54 Appendix A: Physician Survey ......................................................................................... 58 Appendix B: Coder Survey ............................................................................................... 71 vii Appendix C: Coder Responses ......................................................................................... 84 Appendix D: Physician Responses ................................................................................... 88 viii List of Tables Table 1: Summary of coder data collection methods........................................................ 18 Table 2: Summary of Physician data collection methods ................................................. 19 Table 3: Summary of coder demographic variables by frequency and percent ................ 20 Table 4: Summary of physician demographic variables by frequency and percent ......... 22 Table 5: Comparison of physician and coder responses ................................................... 29 Table 6: Comparison of physician and coder responses ................................................... 30 Table 7: Comparison of physician and coder responses ................................................... 33 Table 8: Coder response themes for the open-ended question, "How will ICD-10 impact your job?" .......................................................................................................................... 34 Table 9: Physician response themes to the open-ended question, "How will ICD-10 impact your job?" .............................................................................................................. 35 Table 10: Valence of coder responses to the question "How will ICD-10 impact your job?" .................................................................................................................................. 36 Table 11: Valence of physician responses to the question "How will ICD-10 impact your job?" .................................................................................................................................. 36 Table 12: Coder response themes to the open-ended question, "What aspect(s) of ICD-10 will be the biggest issue for you?" .................................................................................... 38 Table 13: Physician response themes for the open-ended question, "What aspect(s) of the transition to ICD-10 will be the biggest issue for you?" ................................................... 40 ix Table 14: Coder response themes for the open-ended question, "What aspect(s) of the transition to ICD-10 will provide the biggest benefit for you?" ....................................... 42 Table 15: Physician response themes for the open-ended question, "What aspect(s) of the transition to ICD-10 will provide the biggest benefit for you?" ....................................... 43 Table 16: Addition comments provided by physician regarding the transition to ICD-10 ........................................................................................................................................... 44 Table 17: Additional comments provided by coders regarding the transition to ICD-10 45 x List of Figures Figure 1: Age range of survey respondents (physicians only) vs. age range of a 2010 census of actively licensed physicians .............................................................................. 24 Figure 2: Gender of survey respondents (physician only) vs. gender of
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