When it comes to ICD-10, the new code set that takes effect Oct. 1, 2013, what worries Jerra Allen is not the two additional digits or the reams of new disease and diagnosis codes compared with the current ICD-9. Allen, an insurance claims specialist at Miss.-based Hattiesburg G.I. Associates, PLCC, says the biggest challenge will be obtaining the additional information from patients needed to meet the higher level of diagnostic specificity that ICD-10 requires to process claims. "I'm pretty sure a lot of doctors' offices will have that same issue," she says.
For Jacque Konzelman, practice manager at Sussex County Medical Associates in Newton, N.J., the timing of the switch to ICD-10 — in an era of financial and regulatory pressures — is the big stressor. "The problem with all of this is the ability to meet these requirements financially when reimbursement is going down," says Konzelman.
Many practices share these concerns. Yet, given the magnitude of changes practices will have to make — from the way they conduct patient exams to how they process claims — it's alarming that only 36 percent of 722 physician practices in our 2011 Technology Survey told us their technology is ready for the coming transition to the ICD-10 code set, which will require practices to start using more than 100,000 new alphanumeric procedure and diagnosis codes. What's more, 22 percent of respondents told us they're not sure whether their current system will ever be upgraded to handle ICD-10 codes.
Here's another kicker: Although Oct. 1, 2013, the deadline to start using ICD-10 codes, might seem far away, healthcare organizations will have to take their first step in the transition as soon as Jan. 1, 2012: using Version 5010 of the Electronic Data Transaction standard, which is necessary to transmit the new codes.
"It's amazing how many people don't even know about the upcoming transition at all, let alone how big it's going to be," says Glen Stream, president-elect of the American Academy of Family Physicians, who runs the IT management system for a 230-provider, multispecialty healthcare clinic in Spokane, Wash. "The general lack of knowledge is concerning to me."
Translation: You need to make ICD-10 a priority, even though you won't have to start using the new codes for two years. Therefore, the sooner you start, the more likely you'll be able to work out training kinks and avoid claim denials.
Here's a start on what you need to know to stay on target for the next 24 months.
ICD-10 codes: how they'll change your life
With all the focus on EHRs and meaningful use, many practices haven't even begun to think about ICD-10. And while the change to ICD-10 is touted by CMS for its benefits (supporting interoperability, accuracy, and quality of data), the magnitude of the conversion is daunting.
"This ICD-10 thing is just one more change people have to deal with," says Stream. "There's so much going on I think people are saying 'Enough! I'll deal with this later!'"
While the desire to procrastinate is understandable, the longer you wait the more difficult the transition will be, regardless of whether your physicians code their own charges or your practice uses a seasoned, certified coder.
The consequences of not being ready for the changeover to ICD-10 include losing thousands of dollars in claim denials and time spent resubmitting claims. It's even possible your practice could be liable in a malpractice lawsuit if a diagnosis is coded incorrectly and a patient therefore receives inappropriate treatment, says Raemarie Jimenez, director of education for the American Academy of Professional Coders (AAPC).
The change from ICD-9 will be a gigantic one: The new ICD-10 CM (clinical modification) codes and ICD-10 PCS (inpatient procedure) codes will replace the existing ICD-9 numerical codes (which are more than 30 years old) with more than five times as many new alphanumeric codes that are longer and more specific. According to the American Health Information Management Association (AHIMA), ICD-10 consists of more than 68,000 codes, compared to approximately 13,000 ICD-9-CM codes.
What's more, ICD-10 codes are longer — ranging between three and seven characters — than their three- to five-digit predecessors.
This shift will ultimately create more-specific patient data, and contribute to a greater knowledge base about patient diseases and best practices, according to Patricia (Pati) Hildebrand, a consultant with AHIMA who works with practices.
Hildebrand offers the example of applying a code to a patient with hypertension, which represents one of the most common diagnoses in primary care:
Currently, hypertension is coded as a single code, with multiple additional codes to describe related illnesses (effects from hypertension on the heart, kidneys, and eyes for example) or complicating illnesses (diabetes, congestive heart failure).
But starting Oct. 1, 2013, coders will have several hundred codes to choose from. Under ICD-10 — except in rare cases of essential hypertension with no known cause or related organ changes or concomitant disease — a "combined" code must be chosen from several pages worth of codes in the manual (codes I10-I15), such as "hypertension plus kidney disease" or "hypertension plus kidney disease plus cardiac disease."
