November 26, 2013

ICD-10 D-Day: October 1, 2014

2014 will certainly be a year to remember for the American health care industry. From the implementation of the major provisions of the Affordable Care Act, to CMS’s controversial Two Midnight Rule. But likely the biggest change that hospitals and doctor’s offices will deal with on a daily basis is the next iteration of the International Statistical Classification of Diseases and Related Health Problems, better known as ICD-10.

Since 1979, the United States has operated using the ninth iteration of the ICD code system. However much of the world is already using ICD-10, with the majority implementing the system during the late 1990’s and throughout the 2000’s. For the U.S., The ICD-10 “D-Day”, so to speak, is Oct. 1, 2014.

So what are the major differences between the new and old codes? Surely the U.S. health care system has been getting on pretty well without the new ones?

More codes, more problems?

The most important change that ICD-10 brings to the table is an increased level of specificity. For example many of the ICD-9 codes lack the ability to describe important details about particular illnesses.

In an informational paper about ICD-10 from the American Medical Association (AMA), they give the example of a person with a burn on their right arm. Using the current American version of ICD-9, doctors treating the patient would use the same code whether the burn was on the left or the right arm. The same code would also be used regardless of if it was the patient’s first, second, or even third visit for the same condition.

ICD-10 on the other hand would have a different code designation for each of those circumstances. However the tradeoff for that specificity is a nearly exponential increase in the number of codes that doctors need to be familiar with in order to perform their basic duties.

When implementation day comes there will actually be two versions of the new system in the U.S. First is ICD-10-CM (Clinical Modification), which is for diagnosis coding. Second is ICD-10-PCS (Procedure Coding System), for procedure coding during inpatient stays. Overall the number of medical codes is set jump from just about 13,000 right now to approximately 140,000. That’s 127,000 new codes to learn, and they won’t be spread evenly across the medical spectrum.

Certain areas of medicine will be hit worse than others with new codes to learn. The two areas that will need to deal with the most number of code increases are cardiac practices, and orthopedic practices. For cardiologists the number of codes will increase by 2.9 percent, according to numbers from the WHO. Orthopedists though will have to deal with a whopping 16 percent increase in the number of medical codes under ICD-10.

Will ICD-10 be a repeat?

Opposition to ICD-10 in the U.S. has been heavily entrenched for a number of years now, even before the Obama administration mandated the changeover in 2009. The AMA along with other medical groups announced their opposition to the new standard back in 2011. In a press release after the AMA delegates voted to, “work vigorously to stop implementation” of ICD-10, the then AMA President Dr. Peter W. Carmel said in a press release:

“The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients’ care.”

The AMA has since come around as the federal government has not budged from its stance. But it does beg the question though, how will this implementation look? Many doctors and hospitals are wary of big government mandates, especially after the debacle that has turned into. Luckily CMS is now signaling that it may be considering end-to-end testing for ICD-10 for doctor’s offices next year, which could allay some of the worst fears.

An ICD-10 solution?

No matter your opinion on ICD-9 vs ICD-10, the transition is mandatory. All HIPAA “covered entities” need to be using ICD-10 by Oct. 1, 2014, or CMS will not be able to process their claims. Which means those entities resisting the transition will either not be getting paid or will have significant delays in being reimbursed.

One solution for the “ICD-10 blues,” are medical scribes. As you might already know, a medical scribe’s main job is to update electronic health records in real time using ICD codes, instead of the doctor. Medical scribes have become increasingly popular in hospital emergency departments and outpatient private practices where time is of the of the essence and EHRs have slowed down doctors caregiving. For hospitals and practices already using medical scribes the transition to ICD-10 could likely be a lot smoother than for those without.