The ICD-10 (International Classification of Diseases, Revision 10) mandate presents the U.S. healthcare industry with the most complex shift in diagnostic and procedural coding since the move to DRGs in 1983. The deadline is looming in less than eight months and the Centers for Medicare and Medicaid Services has indicated there will be no further delay in the October 1, 2014 compliance date. Facilities have no choice; they must immediately prepare for all aspects of the conversion process to minimize the economic and operational impact of the change.

 

Even well prepared healthcare providers can anticipate a wide range of barriers in their ICD-10 transition within the first six months of the conversion. Many experts predict these challenges could prevent providers from fully realizing the ultimate benefits and improvements of ICD-10 until the second quarter of 2015.

 

The five facts below highlight some of the costly challenges providers will face in their transition to ICD-10.

1. Use of ICD-10-PCS is unique to the United States: The Canadian’s implementation of ICD-10 CA revealed a dramatic increase in coding backlog due to a 50 percent productivity loss in the first six months. However, the study did not take into account coding for inpatient procedures performed in hospitals. The ICD-10-PCS, unique to the United States, classifies procedures performed in hospital inpatient health care settings. The PCS system will result in 3,000 ICD-9 codes increasing to 87,000 ICD-10-PCS codes!

 

2. Results of the HIMSS/WEDI ICD-10 National Pilot Program: The Pilot Program began on April 12, 2012 at the HIMSS G7 event in Nashville, Tennessee and was completed on August 30, 2013. The program was designed to share best practices and lessons learned from early-adopters. The general accuracy rate when coding test claims in ICD-10 was 63%, with the lowest scores for specific codes hovering around 30%. Coders averaged two medical records per hour, compared to four per hour under ICD-9, translating to a 50% productivity decline. Coders often confused the number “0” (zero) with the letter "O” and the number “1” (one) with the letter “l”. The participants of the pilot test were all seasoned, credentialed and trained ICD-10 coders.

 

3. Results of the WEDI Survey: The WEDI survey used a set of questions aimed mostly at status and paralleled those from the February 2012 and February 2013 to facilitate direct comparison. All industry segments appear to have made some progress since February 2013 but have not gained sufficient ground to remove concern over meeting the October 1, 2014 compliance deadline. One-fourth of providers surveyed did not plan to complete their assessment until sometime in 2014, leaving little time for remediation. Forty percent of vendors surveyed indicated they would not have products available to customers until 2014.

 

4. Clinical Documentation Knowledge Requirements for ICD‐10: In addition to technical testing and understanding the reimbursement scheme, physicians will face the need to improve documentation to meet hospital and medical necessity requirements. A key step includes documenting each patient encounter to satisfy the language requirements for complete coding. A comprehensive Clinical Documentation Improvement (CDI) program will be critical for keeping revenue cycles steady and reimbursements flowing during this time of upheaval and confusion.

 

5. Our complex medical reimbursement system: The U.S. health care system carries twice the administrative overhead of other advanced nations. We arguably have the most complex medical reimbursement system in the world. For example, the Medicare Claims Processing Manual is over 4,000 pages in length. Many purport that with ICD-10, the government is perpetuating a reimbursement system that is far too complex.

 

While transitioning to ICD-10 is not an easy task, the future success of providers will be determined by how effectively they adopt the new coding system. In the famous words of Mark Twain, “The secret to getting ahead is getting started.” The positive news is that it’s not too late to craft a successful ICD-10 transition.