On February 16th 2012, the Health and Human Services Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).Don’t wait for the Centers for Medicare & Medicaid Services (CMS) to make its decision about the implementation date for ICD-10, advises David Sayen, a CMS regulatory director. “Even if ICD-10 is delayed, keep on course,” he said, and make sure things are functioning properly. That’s the advice Sayen offers to providers and payers during this time of uncertainty.
ICD-10 was published in the mid 1990’s by the World Health Organization (WHO) and has been adopted by all industrialized countries except the U.S. ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. It will also present an opportunity for detailed record-keeping and enhancement of documentation to support accurate reimbursement.
The transition to ICD-10-CM/PCS will be a defining moment in healthcare, and the future of many healthcare practices will be determined by how successfully they navigate the crossing to the new code set. The current system, ICD- 9, does not provide the necessary detail for patients’ medical conditions or the procedures and services performed on hospitalized patients. ICD-9 is 30 years old, has outdated and obsolete terminology, uses outdated codes that produce inaccurate and limited data, and is inconsistent with current medical practice. It cannot accurately describe the diagnoses and inpatient procedures of care delivered in the 21st century.
Every hospital, physician practice, and payer will need to understand the impacts of ICD-10 on system implementation changes (e.g., revising super-bills to include the new codes or revising electronic health records systems), clinical documentation, and revenue cycle management. Reengineering clinical documentation processes will involve extensive training for physicians, hospital staff, and coders.
We acknowledge that transitioning to ICD-10 is not an easy task, including a number of overlapping timelines, such as those involving Meaningful Use and Health Reform Initiatives, in addition to ICD-10. However, ICD-10 is not a separate, competing initiative, but the foundation for those initiatives. ICD-10 will help us gather information that can help providers do a better job of understanding and serving patients. It will enable us to better analyze this information to meet requirements related to bundled payments, hospital-acquired conditions, value-based purchasing, and preventing readmissions.
There are significant consequences of poor preparation for the transition. As providers, we depend on smooth processing of claims for cash flow, so it’s important that we devote our full attention to preparation. Potential consequences include denials, processing delays, backlogs, DNFB and so on. The good news is that these problems can be mitigated with proper advance preparation.
“It’s not a question about if, but when”, ICD-10 is coming! Even though the future of ICD-10 implementation “date” is uncertain, continue to move forward, especially with clinical documentation improvement, physician education, and technology needs.