One of the most significant changes to the American healthcare system since Medicare and Medicaid was proposed is the change from ICD-9 coding to ICD-10 coding. The World Health Organization (WHO) detailed ICD-9 standards over thirty years ago, but that coding system has run its course and is unable to accommodate advances in medicine that require additional coding numbers.
ICD-10 was subsequently developed by the WHO in 1993 as a replacement coding structure. The primary difference between the two systems is ICD-10’s alpha-numeric structure versus the almost strictly numeric structure in ICD-9. Now at its numbered code limit, ICD-9 has between 13,000 and 14,000 codes. ICD-10 currently details about 70,000 codes with an almost limitless capacity to accommodate future advances in medicine as well as more accurately define conditions.
Preparing for the final implementation of ICD-10 and ICD-10PCS (inpatient coding) on October 1, 2014 has been a process that began several years ago, but as the deadline date approaches, practices throughout the country must develop a plan of action to adapt to many changes including the following:
Alpha Numeric Coding – Because the codes are alpha numeric and can be as many as seven digits long, Practices must understand that encounter forms currently in use will be obsolete. In fact, it might be an impossible task for any practice to continue without electronic billing.
Coding and Billing Staff – While it is believed that most coders will be able to adapt to the new codes, the new system will require a deeper knowledge of both medical terminology as well as anatomy. This may require additional education in these areas to be adequately prepared. Requirements also dictate that both ICD-9 and ICD-10 be used in coding through at least 2016 for tracking purposes. This will be an increased burden on staff and will require complete familiarity with both systems.
Physicians and Medical Staff – While new physicians are learning ICD-10, established physicians will be hampered by changes that require additional documentation and more specific diagnoses for everything from office visits to lab tests to imaging exams. Current Procedural Terminology (CPT) coding will remain in place and unchanged. Medical staff in all areas of outpatient care will need to familiarize themselves with the changes in coding so that tests and exams they perform have appropriate documentation for billing and reimbursement.
Additionally, physicians will need to familiarize themselves with ICD-10PCS which will apply specifically to inpatient coding and will require physicians and surgeons to more accurately define diagnoses for hospital and long term care patients.
Many supporters of ICD-10 point out that the change to ICD-10 has already been made by most other countries with the United Kingdom adopting the system in 1995 and Germany and Canada doing the same as recently as 2000 and 2001. While this is true, most other countries do not use the same system of provider payment as does the US which is heavily dependant on the relationship between Procedure and Diagnosis code to determine the allowed amount for billing. There is legitimate concern that beyond the costs associated with learning the new codes, providers may face serious cash flow issues as the code set is adopted and fully understood. This “learning curve” is something that both providers and payers are grappling with and medical providers will be well served to closely monitor their remittances and maintain healthy cash reserves during this transition period.
As in most cases, preparation is critical to ensuring smooth transition during change. In the case of ICD-10, this preparation extends beyond the clinical coder to the business office and ultimately to the senior financial officer of every practice.