Saturday, February 14, 2015

ICD-10 Debate

An article talking about the upcoming implementation of ICD-10 raises some interesting questions about how the implementation of a new coding system will impact providers.  

The change from ICD-9, a system to which providers have become accustomed, and ICD-10, a system with 5 times as many codes.  The ICD-9 system has 13,000 codes.  The ICD-10 system has 68,000 codes.  Certainly, detail can be a good thing in terms of trying to characterize the exact nature of the problem for the patient and the exact nature of the procedure code. The key is that people have to learn how to use the codes.  Providers have to learn the codes.  Providers have to implement software systems that incorporate the codes.  

For large providers who have large amounts of staff the switch to a new system can be fairly straightforward.  Send the staff responsible for coding for training and keep the training up so that they hone their skills and knowledge.  In addition, if payers penalize for using the incorrect code, larger providers are likely to have sufficient cash flow cushion to brace themselves for a delay in reimbursement--and perhaps even for no reimbursement.

In contrast smaller providers do not necessarily have staff dedicated specifically to this and the providers may not feel that they have the time to dedicate.  Smaller providers also may not have the resources to update their information systems and may not be able to brace for delays in cash flow.  

The problem at a system level is that with some providers prepared for the October 1 mandated change (already two years after originally planned and some two decades after the system was first developed) and other providers not prepared there is a political process that will determine how and when movement occurs.  For those providers who have prepared for the switch, the resources spend on preparation seem like wasted resources.  For those who have not prepared, the resources needed seem daunting.  (Although the article points out that documented costs have been lower than expected.)  And the uncertainty that is caused by not knowing what will happen is also costly.

One suggestion is to have both coding systems available simultaneously.  That will shift the costs of change (or failure to change) to the insurers who need to manage the reimbursement.  

Given that all but one expert on the panel mentioned in the article was in support of moving ahead it seems likely this will occur.  It will be interesting to see what the time for additional public comment yields and what ends up happening on October 1.