The U.S. government now requires the use of ICD-9 codes to report medical diagnoses and inpatient procedures. Next year, it will be replaced by a new version of diagnosis codes and a new procedure coding system called ICD-10. The codes are used by hospitals for inpatient services.
The new deadline for using the new coding system is Oct. 1, 2014. It was moved up from Oct. 1, 2013. Even earlier, the deadline was October 1, 2011.
Which organizations are under the new code?
ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.
The organizations also need to adopt EDI Version 5010. Enforcement of 5010 by the Centers for Medicare & Medicaid Services (CMS) was started on March 31, 2012. That too had been delayed because of slower than expected software upgrades.
In addition, CMS says medical practices really require several years to prepare to implement the new codes. The ICD-10 code includes: the disease category, the disease etiology, body parts which are affected, and the severity of the illness.
“Not only must new software be installed and tested, but medical practices must provide training for physicians, staff members, and administrators,” CMS said in a statement. “They will also need to develop new practice policies and guidelines, and update paperwork and forms. Practices should also create crosswalks that will convert their most frequently used ICD-9 codes to the ICD-10 equivalents.”
Technology can help with the implementation, CMS said.
“Practices should check with their EHR [electronic health record] vendors to make sure they understand the data storage requirements for the new code set; seek online training available through association websites and software-based instruction; and invest in additional technology, such as patient kiosks, to boost productivity,” CMS adds.
In connection with these requirements, BCC Financial Management Service says surveys show that many health-care providers have not made significant progress towards ICD-10 implementation.
Changes in compliance deadlines and other priorities are among the reasons for the delay, the company said.
CMS predicts ICD-10 will at first lead to lower cash flow and revenue loss.
“Denial rates are expected to increase by 100-200% post implementation, with increase in accounts receivable days by 20-40%,” according to BCC, citing studies.
Also, claims-error rates are expected to increase to 6 to 10 percent, instead of the 3 percent rate now with ICD-9.
“The new ICD-10 system implementation for hospitals has become a daunting challenge and time consuming as hospitals have 90-100 affected systems that need upgrades,” Sammy Aboud, senior vice president of Marketing at BCC, said in a statement. “Some of the functions that require upgrades are the replacement software, IT system interface changes, modified system logics, retention of historical data in ICD-9 format and many other tasks.”
“We believe that hospitals should consider outsourcing while coders focus on In Patient and Same Day surgery which represent 70-80% of the hospital’s revenue while they implement the ICD-10 systems,” he added in the statement.
Edited by
Stefania Viscusi
