What is changing and why? Let’s start with a dry but very important accounting of the raw facts. The Department of Health and Human Services (HHS) has mandated industry-wide adoption of ICD-10-CM and ICD-10-PCS code sets by Oct. 1, 2011. ICD-10-CMS will affect all components of the healthcare industry. Ambulatory surgery centers (ASCs) will not be affected by ICD-10-PCS unless they are utilizing ICD-9-CM volume 3 for inpatient procedures.
The two major changes in the ICD-9-CM to ICD-10-CM code sets are structure and detail. The codes will move from a numeric five-character size to an alphanumeric seven-character size. At current count, there are approximately 17,000 ICD-9-CM codes and the possibility of 155,000 ICD-10-CM codes. The codes are far more specific which will allow for greater accuracy.
The reasons for changing the codes are simple and undeniable. The current ICD-9 classification system is ambiguous and lacks enough available codes to address classification of new diseases, illnesses and procedures. As a result, disparate procedures often utilize the same ICD-9 code. This inherent ambiguity often results in costly and inefficient handling of claims. Simply put, this change is necessary, unavoidable and overdue.
For non-inpatient facilities there are some things that will not change. CPT codes will continue to be used for billing, and the greatly expanded ICD-10 codes will now be used for diagnoses. Despite many rumors to the contrary, unspecified codes and basic documentation are found in ICD-10-CM. This gives providers the ability to code using general statements like hypertension and diabetes, and the option to use more detailed codes when necessary. Some providers have expressed concern that they will no longer be able to use “Superbills” after the switch, but a quick search of the American Health Information Management Association (AHIMA) Web site will calm their fears. While AHIMA does not specifically endorse “Superbills,” they do provide many examples on their Web site that are ICD-10 compatible.
Recommendations For An Effective Implementation
Start a cross-functional team that includes representation from both business users and IT staff. Although the IT staff will play a major role, the project of ICD-9 to ICD-10 implementation must be owned by the business users/organization executives. Oct. 1, 2011 may seem far away, but most analysts agree that the significance of the effort will require an implementation schedule of 24 to 36 months. As I write this article, there are only 34 months left. The time to start is now. The failure to do so will present challenging consequences.
When your implementation team is in place, start by performing an inventory of all applications and identify the ones utilizing ICD-9 codes. This list will include applications used for: scheduling, billing, electronic medical records, claim submission, quality management, performance measurement, compliance and stand alone reporting... just to name a few. Be careful that standalone applications and databases are not overlooked, especially if they are home-grown. An accurate accounting of all applications and their functions is critical to ensure proper planning of all future tasks.
Contact all of your vendors and ask them the following:
- Will the application support the new ICD-10 codes?
- Will this be an upgrade to the existing application or a new installation?
- Will hardware requirements change?
- What is their timeline for supporting ICD-10? (ask for a document)
The good news is that most vendors are including support for the new codes in their standard version upgrades. However, many vendors plan to grandfather their current application and require you to purchase a brand new system. This will require extraction of patient data from the old system to the new one, which is rarely a smooth or accurate process. Your staff will need to be trained on the new software in addition to the new codes.
There may also be many systems supported by your IT staff because they are homegrown; vendors have gone out of business; or vendor support has been dropped for applications that were grandfathered long ago. Any one of these circumstances will likely overwhelm the department, and outside assistance may be necessary.
With customization comes complication. Here is where the rubber meets the road. Do you use a stand-alone, homegrown application or database; a standalone reporting system; non-standard customized reports; customized applications to automatically share information; and/or rely on a data warehouse for management of multiple centers? If you answered yes to any of these questions, your project just entered the danger zone.
While many applications are easily upgraded, don’t be fooled into thinking this a standard upgrade. The move to ICD-10 will require major changes to the structure of supporting databases that in most cases will break or invalidate customized applications and reports. These applications will need to be re-written to accommodate the new codes. Every report will need to be re-written to accommodate both ICD-9 and ICD-10 codes. To simplify the message just remember that anything customized must be re-customized.
There are some emerging technologies that will make the transition easier. Several companies including IBM and 3i Infotech are developing vocabulary servers that will allow applications to exchange information in ICD-9, ICD-10 or both.
It is imperative to know how all of this sits in your timeline. Each application may support the new codes at different times. This must then be reconciled with the exact dates that each payor will begin requiring the new codes for billing. Each payor may require the new codes at different times as well. Many analysts warn that there may be a period of two years where billing for both codes will be required.
The benefits of moving to ICD-10 codes are realized by everyone. Providers will see more accurate payments and fewer rejected claims; functional support for emerging technologies and services; and consistent accurate data for outcomes analysis. A decrease in rejection rates will reduce the amount of work for both payors and providers, allowing for faster payment of claims. Improved disease management will result in better care for patients. While there is no denying the challenges that lie ahead, the long-term benefits will far outweigh the pain.
Glen Pridgen is healthcare product specialist at 3i Infotech Inc.