Healthcare's Big Headache: Is ICD-10 Postponement Prolonging the Pain?

If you work with medical documents or health insurance companies, you probably know that you dodged a bureaucratic bullet in 2012. Many in the medical community heaved a collective sigh of relief when Health and Human Services Secretary Kathleen Sebelius announced that the federal government would delay the implementation of a new diagnostic and procedural coding system. The compliance date for the new medical code set ICD-10 (formally known as the International Classification of Diseases, 10th Revision) has been pushed back to Oct. 1, 2014, giving the healthcare industry extra time to prepare for massive revisions to the way it processes medical data for storage, retrieval and payment purposes. Changing these diagnostic codes changes the reimbursement process forllowed by payers, insurance companies and the fiscal intermediaries that handle transactions for the Centers for Medicare and Medicaid Services (CMS). If you work in medical billing, coding or transcription, for example, you already know that the healthcare reimbursement process is convoluted, to put it nicely. Contentious debates over the pros and cons of the new system continue, with many providers saying the new codes will make the process even more convoluted. Most seem to agree that ICD-10 improves on the current ICD-9 system. It has thousands of new codes to better describe medical procedures and diagnoses. There's no doubt ICD-10 will significantly enhance the efficiency of processing claims transactions. Sebelius says the new standards are part of HHS efforts to curtail paperwork and resolve problems that waste time and significantly delay payment. Transaction rejections and misrouted requests are cited as common issues faced by providers, for example. But ICD-10 implementation affects healthcare industry workers at the same time they're dealing with other industry change in bundled payments, electronic medical records and accountable care organizations. There are new standards to accommodate electronic funds transfers (EFT) between healthcare providers and health plans. There are also new rules involving electronic transactions to determine patient eligibility for coverage and to establish the status of a healthcare claim by a health insurer. So ICD-10 is only the biggest hurdle faced by healthcare workers on an already- treacherous obstacle course. American Medical Association President Peter W. Carmel publicly thanked Sebelius for the delay, but added: "The timing of the ICD-10 transition could not be worse for physicians, as they are spending significant financial and administrative resources implementing electronic health records in their practices and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance.” In other words, there's no easy way to implement everything instantaneously. There's no way to jump into the new system all at once because preparation and testing are a huge part of the process. "Burdens on physician practices need to be reduced—not created—as the nation's healthcare system undertakes significant payment and delivery reforms," Carmel said. For its part, CMS says providers gearing up for the switch need to:

• Identify how ICD-10 codes differ from ICD-9 codes for the most common diagnoses
• Identify what additional documentation or language you will use ensure the correct ICD-10 code
• Determine protocols for entering key words, medical notes and content in medical records
• Share ICD-10 code interpretation from testing with colleagues to minimize confusion and miscommunication

CMS publishes an ongoing compilation of ICD-10 transition updates here.