Yakima Herald Republic
March 30, 2015
By Molly Rosbach
Say you find yourself in a spacecraft, and all of a sudden, you crash and hurt yourself.
In ICD-10, there’s a code for that.
ICD-10 — the International Statistical Classification of Diseases and Related Health Problems, version 10 — is scheduled to be the new national standard for medical coding come Oct. 1, six months from now, as mandated by the Centers for Medicare and Medicaid Services, or CMS.
Medical coding is the system by which medical providers document patients’ various illnesses and injuries, and which allows them to bill specifically for office visits and procedures. Without accurate coding, they don’t receive reimbursement from Medicare or Medicaid or private insurers. Theoretically, the more detailed and specific the coding, the more providers will be properly reimbursed for patient services.
“The people who pay for health care want to be sure you’re doing the right thing, for the right reason, at the right time,” said Dr. Carl Olden, chief medical information officer at Yakima Valley Memorial Hospital and a primary care physician. “You have to tell the story in more detail. We don’t want the CliffsNotes; we actually want the novel.”
The existing coding system, ICD-9, has been in place since 1975 and contains 13,000 diagnostic billing codes.
ICD-10, adopted by many countries worldwide in the 1990s, has 68,000, more than five times as many — and that’s not counting procedure codes, for the treatment side. So obviously, it includes a lot of codes that aren’t available in ICD-9, and providers and payers alike are feeling anxious about the transition.
“It’s going to be rocky,” Olden said. “It really is an entirely different system,” with alpha-numeric codes up to seven digits long, compared to three- to five-digit codes in ICD-9.
(The Healthcare Dive, an online publication, last year posted a list of the “16 most absurd ICD-10 codes,” including, but not limited to, “Struck by duck,” “Burn due to water-skies on fire,” and “Walked into lamppost.” These are real codes.)
While the volume of codes is daunting, ICD-10 is meant to improve medical documentation and, in the long run, allow providers and payers to have a more comprehensive understanding of population health, which should in turn lead to more preventive health care and reimbursement based on providers’ ability to keep patients healthy.
Industry urges caution
ICD-10 has been delayed several times since it was first mandated by CMS in January 2009, prior to and separate from the Affordable Care Act. Most recently, it was postponed for a year last March, to 2015.
Another delay is still possible, but providers here say the October date looks solid and they’re proceeding under the assumption that Oct. 1 will be go-live day.
In fact, many local providers have been preparing and training for ICD-10 for the past few years, regardless of recurring delays.
“We’re ready to go with it,” said Dr. Mike Maples, CEO at Community Health of Central Washington. “Our concern is that the people to whom we transmit that information are not going to be ready to deal with it.”
Industry consultants are urging clinics and hospitals to build up cash reserves or lines of credit so they can sustain their practice for up to six months, in case the payers or other vendors don’t sort out their end in time.
The fear is that if providers like Community Health start billing an insurance company using ICD-10 codes, but the insurer isn’t prepared to process claims with the new codes, it will block the cash flow of reimbursement back to the provider.
A March 4 letter to CMS from the American Medical Association and 99 other groups expressed concern that recent testing showed the claims acceptance rate in Medicare would fall from 97 percent to 81 percent if ICD-10 were implemented today. The AMA has long opposed the transition to ICD-10.
“Those revenues are crucially important to supporting hospitals” and other providers, said Bob Perna, policy director at the Washington State Medical Association. “If you can’t get those to function in the near term, you could see some serious cash crunches in the provider community.”
Other anticipated costs from the new system include some lost productivity as providers struggle to incorporate the new codes into their everyday practice; lost reimbursement if they code incorrectly; and software upgrades to keep the program functioning over time.
Individual organizations’ electronic health records systems will play a big part in how easily providers make the transition; some will prove better than others at generating shortcuts or suggesting codes based on the provider’s notes, experts say.
Practice, practice, practice
At Community Health, Maples said, providers are already coding in ICD-10, with ICD-9 mirrored in the electronic health records system so the codes will automatically transition in October.
Memorial is dual-coding as well, and testing by sending ICD-10 codes to payers able to accept them, vice president and chief information officer Jeff Yamada said. Training started in earnest in January 2014. Memorial will hire extra staff to help with coding during the transition, he said, but it plans to be fully prepared for the switch.
Perna said WSMA has been holding work groups with providers and insurers to do “as much pre-planning and problem-avoidance issues as we can.”
Yakima Valley Community College’s Medical Billing and Coding program has been teaching ICD-10 alongside ICD-9 since 2012, instructor Sandy Erlewine said, and will probably continue teaching ICD-9 at least through next spring so students can still learn to handle older claims that haven’t been processed by the Oct. 1 changeover date.
The school’s Allied Health Center of Excellence offered discounted online workshops on ICD-10 in 2013 and 2014 to community members, aiming to provide the local health care workforce with more resources to prepare for the new system.
“I would say that they are in high demand,” Erlewine said, adding that the demand for certified medical coders will only grow as baby boomers age and require more health care.
Perna said small providers might face more challenges in adapting to the new system than bigger organizations, like hospitals or community clinics, that have more resources to dedicate solely to coding and billing, as well as to analyzing the vast amounts of new data they’ll have on patient populations.
However, he said, smaller offices should also have a more limited scope of codes that they’ll need for patients, whereas hospitals or multi-specialty clinics will have to be familiar with a wide range of codes.
A lot of the buzz around ICD-10 has been negative, doomsday forecasting, as providers brace for the vastly more complicated system. It’s hard to see the benefits, experts say, especially when the medical community is already weighed down with documentation requirements for things like electronic health records and patient-centered medical homes.
“I think in the future-future, it will be transformative; I think right now, everybody views it just as another change,” Yamada said. “Us that are kind of more in the industry, we can see the gradual evolution and steps moving forward, but no one has really communicated well what’s the bigger picture of this moving forward.”