Doctors and hospitals struggling with ICD-10 preparedness


ICD-10, the new coding system that you as a doctor will be using to classify diagnoses and medical procedures – tentatively beginning on October 1st – is proving harder to solve than the Zero Theorem. The conundrum for hospitals, physician groups, insurance companies, and IT firms has to do with the fact the number of codes will increase to 68,000 in ICD-10 from ICD-9’s 14,000. In the preceding almost 40 years since ICD-9 was implemented, multiple injuries, diseases, and procedures have emerged. As a result ICD-10 had to be comprehensive enough to specify which foot a broken ankle is on, among other, more surreal events.

For example, if a patient got hit with a turtle, you would report it using the code W59.22XD. For a crocheting stab wound, you would use Y93D1. And if someone is sucked into a jet engine, that would be a V97.33XD. As you can see, ICD-10 is an alphanumeric system, as opposed to the numeric-only ICD-9. Additionally, the United States version of the code will be used for payments as well. In fact, ICD-10 will determine how the $2.8+ trillion Americans spend on medical care every year will be paid out. All told, the amount of database fields have to be multiplied and their length extended to make room for the number of codes – some of which are pretty long. More importantly, medical billing systems and insurance claims systems must be in the same wavelength.

Achieving that affinity is both complicated and costly. Many hospitals have separate inpatient and outpatient billing systems and ancillary billing systems used by different departments. These systems have to be upgraded so that electric medical records (EMR’s) comply with ICD-10 – a process on which hospitals, practices, and insurers have spent over $100. Furthermore, medical facilities have to test and retest these systems with big – insurers like United Health, WellPoint, Aetna and Blue Cross – as well as small payers. Approximately 186,000 medical coders in hospital administrative departments transcribe doctor’s notes into ICD codes which are used by insurers to establish how much to pay hospitals and private doctors for the treatment they have administered. A slight oversight could cost hospitals or doctors money.

All of the above has caused the implementation of ICD-10 to be delayed twice – and rumor has it a third delay may occur. These delays have cost healthcare and insurance providers anywhere from $1.2 to $6.8 billion, according to the CMS. Hence, the College of Healthcare Information Management Executives and the American Health Information Management Association are pleading with Congress to preserve the current deadline and hit the ground running, as it were. A pilot test the CMS conducted last March with 2,600 participating providers, suppliers, billing companies and clearinghouses showed that 89% of 127,000 test claims submitted with ICD-10 coding were accepted. The first round of Medicare ICD-10 testing will be held the week of January 26th.

ICD-10 has both benefits and risks. The scariest part for healthcare providers is that there will be no transition period. On October 1st it will be like ICD-9 never existed – with the exception of medical billing filed before that date. So far removed is ICD-10 from ICD-9 that old Cobol-based claim adjudication systems have to be mapped to the new database to keep data from becoming lost in the shuffle. The consequences of not deploying ICD-10 properly could potentially be measured in the billions of dollars. On the other hand, ICD-10 is expected to improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and offer detailed data to inform healthcare delivery and health policy decisions. Additionally, the new coding system will improve quality measurement and reporting capabilities,  tracking of illnesses and will reflect greater accuracy of reimbursement for medical services. 

Related Read:

What is ICD? What’s the difference between ICD-9 and ICD-10?