4 Predictions on the Switch to ICD-10

On Oct. 1, 2013, ICD-10-CM (clinical modification) and ICD-10-PCS (procedural coding system) will be implemented into the HIPAA mandated code, increasing the number of codes from around 13,600 under ICD-9 to around 69,000 under ICD-10. Here are four predictions from various news reports, studies and editorials on the massive coding overhaul.

1. Coders may never regain ICD-9 levels of productivity. ICD-10 will impact productivity of healthcare organizations on many levels, slowing the process of documentation, entering new codes and payor communication, according to an AAPC release. According to the release, documentation is the most obvious and largest area to have an impact on productivity. Providers and physicians will likely need to be queried for additional information when documentation lacks necessary elements for ICD-10 code selection, delaying the submission of claims. The process of entering new codes will also slow down because of the switch to alphanumeric codes rather than simply numeric.

According to a blog post published by Tom Sullivan in ICD-10Watch, the real question is whether coders will ever regain the level of ICD-9 productivity with ICD-10. He believes the answer is no: The American Academy of Professional Coders, for example, has said that productivity will not return to normal upon implementation as providers assess how payors interpret the new system. Canadian coding experts have added that productivity in Canada, which has already adopted ICD-10, never returned to ICD-9 levels after implementation. Mr. Sullivan said there may be no way to regain productivity given the extra time it takes to use more codes and more digits.

2. Medical coder demand will increase significantly. The shift to ICD-10 could create thousands of jobs as hospitals and other healthcare facilities adjust to an initial delay in claims submissions, according to a Tampa Bay Business Journal report. Because ICD-10 presents a challenge for even experienced coders, coders with in-depth knowledge of the new system will likely find job openings at hospitals struggling to adapt to the change. Coders may also have opportunities to work as billing consultants and training leaders, as every healthcare facility helps its staff members familiarize themselves with ICD-10. States are already seeing a boost in coder training and demand — Minneapolis-area colleges are offering separate ICD-10 classes so that students will have proficiencies in ICD-9 and the new system by the time they graduate, and the Michigan Economic Growth Authority has approved a $2.2 million tax credit to create new medical coding jobs in the area.

3. The move to ICD-10 is expected to cost $1.64B. The Centers for Medicare & Medicaid Services estimate that the transition from ICD-9 to ICD-10 will cost the healthcare industry $1.64 billion, according to a Wall Street Journal Health Blog report. The switch is also estimated to increase the number of claims returned for improper coding by 10 percent initially. According to the 22nd Annual HIMSS Leadership Survey, sponsored by Citrix, implementing ICD-10/CPT-10 is the top financial IT priority for healthcare provider organizations in 2011. Forty-eight percent of respondents said ICD-10/CPT-10 were the top priority for their organization, followed by upgrading patient billing system information (14 percent) and upgrading patient access system (4 percent). Respondents also named implementing medical necessity checking, patient scheduling systems, eligibility transactions with payors and claims transactions directly with payors as priorities.

4. Facilities and practices are stalling on necessary upgrades. Experts believe hospitals, ambulatory surgery centers and physician practices may be putting off IT upgrades necessary for the conversion to ICD-10, a move that could prove disastrous when the Oct. 1, 2013 deadline arrives. According to an article published in the March edition of Physician Practice Options, physicians should start planning now for the implementation of ICD-10, as the switch to the new coding system is expected to affect every function performed in a medical practice. Rhonda Buckholz, vice president of business and member development for the American Association of Professional Coders, wrote in the article, "Practices will have to revise their super bills or eliminate paper super bills altogether" — a significant undertaking, especially if practices wait until the last minute.

A post in the Wall Street Journal Venture Capital Blog pointed out that hospitals and practices that don't meet the Oct. 2013 deadline for ICD-10 will face fines from HHS. Providers making the ICD-10 conversion also have to update the electronic format to transmit claims from 4010A1 to 5010, which is required by Jan. 1, 2012.