On October 1, 2013, healthcare providers will begin using ICD-10, a new diagnosis coding system replacing the previous system, ICD-9. While this date may seem far away, the fact is, providers need to start getting ready now for this extremely complex conversion.
“While it may seem a long way off, it really isnt in terms of preparing for the education, expense, planning and administrative burden that implementing ICD-10 will require,” explained Leslie Witkin, president, Physicians First, Inc. “Providers should be in planning stages now; this is the time to get committees set up to figure out how their practices will deal with this change operationally, and to begin educating internal staff.”
The change from ICD-9 to ICD-10 requires much more than learning new codes. The new system dramatically expands the number of diagnosis codes from 17,000 codes in ICD-9 to 68,000 codes in ICD-10. “In ICD-9, the maximum number of digits in each code was five,” added Witkin. “In ICD-10, there are a maximum number of seven digits in each code, and the format now includes alphanumeric characters, which ICD-9 did not.”
In addition to adapting the ICD-10 codes, the government provided an additional mandate prior to the systems implementation which requires providers to convert to a new electronic format for computer systems, called HIPAA 5010. This standard must be in place in all healthcare entities as of Jan. 1, 2012.
“One of biggest expenses that providers will face is in meeting this new electronic standardno ones software program is programmed for this,” said Witkin. “Technical contracts dont include the waiver, “If the government sets the world on its head, well pay for the upgrade.”
According to The Impact of Implementing ICD-10 on Physician Practices and Clinical Laboratories, a report to the ICD-10 Coalition by Nachimson Advisors, LLC, the cost of converting to ICD-10 and HIPAA 5010 is quite an expensive proposition. The report estimates that the potential cost to a small practice would be $83,290; the cost to a medium practice of 10 providers would be $285,195; and the cost to a large practice of 100 providers would be roughly $2.7 million.
“When youre looking at expenses like this, you can see why its very important that physicians begin planning and budgeting for this conversion now,” said Witkin. “In addition to the costs of educating physicians and staff on the new codes, practices will need to update their forms and processes to capture significantly more information.” Without proper education, Witkin also warns that practices could see cash flow disruptions due to denials and delays.
“Many practices use what is called a Superbill right now, which enables them to check off the codes on a form,” she continued. “One family practice entity took their two-page Superbill and converted it for use with ICD-10. That two-page bill is now an administratively burdensome nine-page document.”
One of the reasons for the increase in code numbers is that ICD-10 is much more specific than ICD-9. “ICD-10 provides for greater specificity; instead of four diagnosis codes to cover varicose veins, there are now eight or nine codes just for varicose veins of the right lower extremity,” said Witkin. “The goal is to move into an environment where payers pay for quality and efficiency.
“ICD-10 allows for a greater determination of quality care as the government moves to a pay-for-performance requirement,” she added. “The government doesnt want to be passive payer anymore; they want to be active purchaser of quality care.”
Despite the increased cost for physicians, Witkin doesnt expect to see these costs passed on to patients. “With Medicare, physicians are only billing patients their deductibles and a 20 percent copay,” she explained. “The allowed amount is not going up. Contracts with managed care companies are also not changing. So while there will be an enormous expense for physicians, those costs wont be shifting to patients.”
In order to prepare for all of the upcoming changes, the government and many health organizations have begun offering programs on the subject. The Centers for Medicare and Medicaid Services provides audio programs that healthcare providers can access for free, and they also have a specific section on their website dedicated to ICD-10. The American Academy of Procedural Coders is also offering programs to its members. “I presented my first program on July 9, and the response was overwhelming,” said Witkin. “People were saying, “Wow, Im glad we did this now.”
