New medical coding standards are a long time coming

Medical coding standards will completely change when ICD-10 is implemented.The medical coding profession is going to see a complete overhaul with the implementation of ICD-10. The collection of disease codes is set to replace the current standard, ICD-9 no earlier than Oct. 1, 2015. This new deadline is the result of the latest in a series of delays that have been pushing back the system’s implementation since the 1990s.1 The upgrade of the system will be the first upgrade of the coding system that the U.S. government has required of practicing health care providers since 1975.2 However, many professionals in the field are less than enthusiastic about the change. A series of logistical headaches have many wondering if an updated code bank would have any value at all.

The purpose of ICD-10

The International Classification of Diseases is a global standard produced by the World Health Organization that assigns various illnesses an alphanumerical code. The ninth edition of this code, which was published in 1977, has been used by the U.S. medical industry to indicate diseases on insurance claims.3 This version, ICD-9​, has been the standard for medical professionals for over 30 years. However, there has been a concerted effort to upgrade to ICD-10 in order to keep up with the pace at which medical practice has changed in the last few decades.

In 1990 the WHO published the update ICD-10.4 This new set of codes is incredibly more detailed. It takes the approximately 14,000 codes in ICD-9 and expands them to about 69,000. With this increased breadth comes a focus on specificity in the new system. For example, ICD-10 allows doctors and medical coders to differentiate between a right leg laceration and a left leg laceration. The high level of specificity is intended to provide more information not only to the insurance companies that process the claims, but also to the patient’s medical record where the information is stored.

Medical practice has changed substantially since the 1970s, and yet the knowledge that doctors have today is not reflected in the current coding standards. With new diseases emerging in the national population, health care professionals need a system that is dynamic enough to facilitate these changes. ICD-10 increases the maximum code length from five to seven characters, providing the tools needed to adapt to new health threats as they develop.5 Having longer codes also means that physicians can mark the complexity or severity of a condition and the medical coder will be able to reflect that information in the code. The goal is to move toward an automated claims adjustment process, though in order to do so, the codes health care providers are using to document illness need to contain within them a higher level of detail.

ICD-10’s history of Repeated delays

Requiring care providers to switch from ICD-9 to ICD-10 has been met with significant challenges. Repeated delays have plagued the process that was supposed to have been enforced by Oct. 1, 2013. Twice the deadline for mandatory implementation of ICD-10 has been pushed back by one year. Now, with the passage of HR 4302, health care providers will not be required to use ICD-10 until after Oct. 1, 2015.6 The wording of this particular piece of legislation has many in the industry worried.

The law simply states that medical offices across the U.S. will have at least until 2015 to appropriately train their staffs and prepare for the switchover. However, it doesn’t say that the full implementation of ICD-10 will go into effect at that date. The Centers for Medicare and Medicaid Services could put it off for another year, or five years, and still be in compliance with the law.

The repeated delays are causing many industry professionals to quickly lose hope in the new standards. It costs offices a substantial amount of time and money to train their staffs on the new system. Every time the launch date gets pushed back by another year, the medical practices lose those funds. In addition, training managers emphasize the need to spend the last six months before the implementation date doing trial runs to ensure that everyone is up to snuff. However, if they don’t have a firm launch date, planning this out becomes next to impossible.

Is it worth the trouble?

The problems with the institution of the new coding standards have many physicians growing skeptical of the system. On the one hand, increased detail in the code itself means an increasingly complex method of recordkeeping. This opens the door wider for the possibility of insurance companies denying claims on the grounds of coding errors. When insurance companies deny claims, doctors don’t get paid, and entire practices risk going bankrupt.

Besides the efficiency of the new code, many medical services providers are simply skeptical of the government’s ability to successfully institute comprehensive change. With the recent Healthcare.gov snafu still fresh on everyone’s mind, each progressive delay of the ICD-10 rollout gives industry insiders even more cause for concern. Seeing as the new coding standards will cause substantial changes in the healthcare industry, professionals will be keeping a close watch on the government’s actions as the deadline grows nearer.

1″ICD-10 Delay Creates Headaches,” David F Carr, Information Week Healthcare, 3 April 2014, http://www.informationweek.com/healthcare/leadership/icd-10-delay-creates-headaches/d/d-id/1174112 

2″ICD-10 Implementation Guide for Small to Medium Practices,” Centers for Medicare and Medicaid Services, October 2011, http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10SmallandMediumPractices508.pdf

3″Providers Expect Short-Term Pain from ICD-10 Delay,” Greg Slabodkin, HealthData Management, June 27, 2014, http://www.healthdatamanagement.com/news/Providers-Expect-Short-Term-Pain-from-ICD-10-Delay-48303-1.html

4″ICD-10 Implementation Guide for Small to Medium Practices,” Centers for Medicare and Medicaid Services, October 2011, http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10SmallandMediumPractices508.pdf

5″ICD-10 Implementation Guide for Small to Medium Practices,” Centers for Medicare and Medicaid Services, October 2011, http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10SmallandMediumPractices508.pdf

6″Providers Expect Short-Term Pain from ICD-10 Delay,” Greg Slabodkin, HealthData Management, June 27, 2014, http://www.healthdatamanagement.com/news/Providers-Expect-Short-Term-Pain-from-ICD-10-Delay-48303-1.html

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