Jimmie Hebert
CMC, CMIS, CMOM

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May 20, 2012

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ICD-10: Where is it? When is it?

ICD-10 is out there. Did you know that we are the only country on the planet that has not converted to the ICD-10 system? ICD-10 has been trying to make its debut in our country for more than ten years now. Currently, the implementation date is set for October 1, 2009.

ICD-10 has over 200,000 diagnosis and procedure codes, ICD-9 has a little over 16,000. ICD-10 codes are all alpha-numeric codes while ICD-9 codes are numerical codes with the exception of V-codes and E-codes. ICD-10 will allow us to code to a much higher specificity and after all, that is the name of the game when it comes to coding our patient’s diagnoses for their insurance claims.

Providers and payers will need to completely redesign their business processes and systems to be able to handle this massive coding system. Although other countries have switched to ICD-10, no other country uses a version as complex as the US version.

There is a coalition of physicians, labs, and other providers and insurers that are urging Congress to push back the date. This group is urging for an implementation date of 2012 and here is why:

• Providers and payers will have to overhaul their business processes and systems. They will have to get their staffs educated and trained concerning the new ICD-10 system and their new software system to support it. This will be a costly venture. It is estimated that it could cost close to 14 billion dollars across the country.
• Physicians will not be able to rely on clearinghouses to translate their claims to a HIPAA compliant format before forwarding them on to the payers. ICD-9 codes cannot be translated to ICD-10 codes. There is no crosswalk as this is a completely different system.
• The current version of HIPAA transactions (4010) will not work with ICD-10. The industry will have to move to the newest version (5010). This is a major re-write and includes more than 850 individual changes. The ‘Workgroup on Electronic Data Interchange’ (WEDI) is concerned that upgrading to 5010 is too significant to be done in conjunction with ICD-10 implementation.
• Medicare is undergoing the largest contracting change in its history. They are transitioning more that 50 intermediary and carrier contracts to 15 Part A and B Medicare Administrative Contractors over the new few years. This requires transferring workloads from multiple contractors to a single entity, while at the same time integrating Part A and B claims processing systems and modernizing CMS information and accounting systems. This massive consolidation has the potential to cause major service problems for Medicare. Switching to ICD-10 so soon could further overwhelm Medicare and cause major backlog in claims processing and delayed payments to beneficiaries and providers, and increased opportunity for fraud. Medicare’s improper payments could soar.

The industry is hoping to begin the implementation date in 2009 after providers and payers have implemented version 5010 and Medicare contracting changes are finished. The providers and payers would then need 3 years to implement ICD-10 making the full implementation date 2012. It will be interesting to see what happens!

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