Billing & Coding

ICD-10: Experts Fear Executive Attention Lags

By Christopher Danzig

Assessing organizational readiness for ICD-10 requires top-level commitment

Given the historic changes—and challenges—facing hospital executives, it's no wonder it is hard to get them to focus on something that doesn't take hold until October 2013. And the fact that the "something" is often considered a back-office function doesn't help either. After all, coding is not headline-grabbing material.

Nonetheless, Oct. 1, 2013, looms large. That's the compliance date for switching to the new medical procedure and diagnostic coding system, commonly referred to as ICD-10. The transition will allow more accurate reporting for Medicare and other reimbursements by raising the number of codes to more than 140,000, up from roughly 17,000 under ICD-9.

In the race to get ready for this mammoth change, hospitals currently trail their counterparts in the payer community. Many providers have not prioritized ICD-10 preparation, focusing instead on other pressing issues such as electronic health records and figuring out the effects of the health care reform law. Many insurers, on the other hand, have a stronger understanding of ICD-10's overall cost and impact on their organizations, says Christine Armstrong, a principal at Deloitte Consulting.

Experts urge hospitals to pick up the pace so they don't get left behind. "The codes appear in all kinds of different systems," says Nelly Leon-Chisen, the American Hospital Association's director of coding and classification. "The more sophisticated a hospital is, the more applications you're going to have where the codes show up."

First, providers need to inventory information systems throughout their organizations. Many providers, especially research or academic medical centers, will discover soon-to-be outdated ICD-9 codes in such unexpected places as research databases and credentialing tools. Many systems may need to be upgraded or replaced.

Providers also need to evaluate where information is exported and reported. And administrators need to know ICD-10 preparation goes beyond an IT project. "It needs to be business-driven," says Rich Cullen, executive director of national program development, Blue Cross Blue Shield Association. Top-down support will help everyone else get behind the transition effort, he says.

Coders and medical staff need training on the new system. To maintain accuracy and efficient workflow, doctors have to learn to report details that weren't necessary with ICD-9. Providers need to work with software vendors and payers to start testing ICD-10 updates. "You can't do that the month before [the new codes take effect]," Leon-Chisen says. If codes are incorrect and if software or payer contracts aren't up-to-date by the deadline, reimbursement levels could drop.

Armstrong says providers should assemble multidisciplinary teams from across the organization and create timelines with milestone events and costs leading to the implementation date. The schedule should include checkups after the deadline to make sure things run smoothly.

It's a chance for providers and payers to collaborate. Armstrong says everyone should ask, "How do I use this transition in a way that benefits my organization?"

This article 1st appeared in the July 2010 issue of HHN Magazine.

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