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The way Garri Garrison sees it, ICD-10 favors neither payers nor providers when it comes to reimbursement schedules. “It gives both of them more power to negotiate their contracts,” says Garrison, director, consulting services for 3M Health Information Systems. The granularity of ICD-10 will give payers more ammunition about understanding their costs. But on the provider side, the system will enable better tracking of disease progression and details on treatment plans rendered. “Physicians are overwhelmed by the changes in the coding schematic,” she says. “But they are excited about the granularity. It gives them more power to use data, rather than relying on chart review to find the information they are looking for.”

Other industry observers have a more jaundiced view of ICD-10’s impact on payer-provider relationships. “There’s no reason to go to ICD-10 unless you want additional granularity in codes on claims,” says Robert Tennant, senior policy advisor at the Medical Group Management Assocation, a Denver-based organization representing 13,700 group practices spanning 275,000 physicians. “But in order to get the most granular code, you may need more tests. Will CMS and commercial plans pay for more tests to get to more granular codes?”

Tennant cites a recent study provided a Blue Cross Blue Shield of Arkansas that analyzed claims pertaining to the treatment of sinusitis, a common complaint. About six ICD-9 codes apply to the condition. Despite that, more than four out of five claims were submitted to the payer as unspecified, meaning no particular details were available. “There are 14 codes under ICD-10 for sinusitis, including unspecified,” he continues, raising the scenario of equally large numbers of claims being submitted under ICD-10 as unspecified. “Physicians might get paid, but then there is no value in moving to ICD-10. So health plans could take different approaches to their requirements. Each plan may have hundreds of products with different fee schedules asking for differing levels of granularity. That is a huge issue not yet resolved.”