Transition from Icd-9 to Icd-10 Codes and the impact
on U.S. Healthcare
Abstract
A
regulation was passed that requires
replacement of ICD-9 with ICD-10. These practices are facing a staggering
number of technology requirements, including health information technology
adoption, upgrading administrative transaction, e prescribing, and many others.
Hospitals in the United States upgrade multiple information technology systems
so that they can support the conversion from ICD-9 to ICD-10.
Introduction
In this chapter, implementing a variety of strategies is
imperative. Regulatory compliance helps to achieve the highest possible levels
of operational efficiency and effectiveness. “ICD-10” is an
abbreviated term that refers to International Classification of Disease, Tenth
Revision, Clinical Modification (ICD-10-CM). It is a code set and updated
version of ICD-9-CM Volume 1 and 2. Previously, in the United States, ICD-9 was the set code used to report
diagnosis and inpatient procedure. The healthcare industry undergoes a
transition from ICD-9 to ICD-10 codes. The requirement of significant medical
coder technical training for ICD-10-CM/PCS in an organization should assess the
current and anticipated reporting needs or requirement
of external stakeholders. The regulations of federal require all entities
covered by the health insurance accountability and portability. For instance,
the acts (HIPAA) to use ICD-10-CM/PCS codes are set for dates of service or discharge for inpatients that occur on or after
October 1st, 2014. The
diagnosis of ICD-10-CM code sets must be used in all healthcare settings,
whereas the ICD-10-pcs procedure code is mainly set to be used solely by
hospitals for reporting hospital inpatient procedures (Optum Insight, 2012).
Rationale
However,
focus on healthcare data integrity that lead to the adoption of ICD-10-CM/PCS will allow the healthcare industry to
reflect better, to have consistent data, and report comparability. It is
important to note that ICD-9-CM will no longer be
maintained after ICD-10-CM/PCS is implemented.
Literature
review
Potential
implementation cost and impact
Potential
benefits of icd-10 implementation are very substantial. To achieve them,
healthcare providers require making hard choices around capital investment and
operating budgets. For example, the estimate of the Rand Institute
implementation will cost healthcare providers between
$425 million and $1.15 billion in total. Additionally, there will be $5 to $40
million a year in lost productivity. The
impact of ICD-10 to healthcare providers will include multiple system upgrade
and testing cycles, increased the needs for human capital, significant
training, delayed payment, reduced reimbursement and impacts on cash flow, and
more complex during financial reporting.
In
the United State, hospitals are likely to upgrade multiple information
technology systems so that to support the conversion from ICD-9 to ICD-10. Since
ICD-10 is a complex code structure,
implementing associated changes in electronic health records, billing systems,
reporting packages and analytical systems will require either major upgrades of multiple system or
replacement of the older system. According to
Grider & American Medical Association (2010), the transition will necessitate
capital cost that increase and outlays staffing to map and load codes, develop
new reports, map dual coding systems, revise system interface, and eventually retain
the users. The changes in the system will affect nurses, patient,
physicians, financial services and finance, management case, administrators and
other staff.
The
adoption of ICD-10 requires significant
technology changes for providers’ IT vendors, trading partners, external
reporting entities and third-party payers. All external organizations or systems are reporting or accepting diagnostic, and procedure codes will require
ability and modification to run dual-processing solutions. Cross work analysis,
significant testing and data aggregation over time will be essential to prepare
for the ICD-10 transition. The diagnosis of
ICD-10-CM code sets must be used in all healthcare settings, whereas the
ICD-10-pcs procedure code is mainly set to be used solely by hospitals for
reporting hospital inpatient procedures as stated by (Grider & American Medical
Association 2010).
Productivity
loss in healthcare centers is anticipated
in the functional areas that use ICD-9 codes on a routine basis. However, there
are increased number of claims denials due to poor
understanding of new codes set and coding
requirements. Therefore, providers must prepare for this productivity reduction
in order to prevent negative impacts to
cash flow and reimbursement. Medical staff, coders, nurses, and allied health
providers should enroll in training programs on revised and new clinical
documentation requirements and coding nomenclature. Training needs anatomy and
physiology courses, detailed clinical documentation requirements, coding
practice experience with real-time
feedback, and general awareness sessions for staff that currently use ICD-9
data. Practices that are carried out by physicians face financial and
operational burden from ICD 10 implementations and other technological
requirements. Typically, most physicians do no employ coders and thus are
responsible for ICD-10 code assignment that potentially increases the risk of
coding errors. The movement from ICD-9 to ICD-10 procedure codes and diagnosis raised privacy risks and protected health
information security. Furthermore, it support health reform measures and becomes
essential to accurate research information, billing and outcomes analysis.
Conversion
of ICD-9 to ICD-10
Many
people believe that ICD-9 codes sets have become too outdated and are no longer
workable for reporting, treatment, and payment process today. Since the year 1978, ICD-9
has been used widely in the U.S. The WHO organization endorsed ICD-10 in
the year 1990 and since then many countries have adopted the versions of it. Bowie,
(2013)demonstrated how diagnoses of
ICD-9 codes are dived into chapters based
on body systems. Due to lack of codes within the
proper chapter, new codes are assigned
to chapters
of other body systems. For instance, new cardiac disease codes may be assigned
to the chapter for disease of the eye. Codes rearrangement makes finding
the code that is correct and more complicated.
Additionally,
ICD-9 is replaced since there is an increase in the specificity of ICD-10. It is believed
that, the most specific data can provide better data for a particular diagnosis
trends, epidemic outbreaks, public health need, and bioterrorism events. Therefore,
codes that are precise are majorly supported by some potential benefits through
claims that are fewer rejected.
Methodology
Preparation forICD-10 requires the following:
Identification
of the current system and work process, either manual or electronic, in
which you use ICD-9. When it comes to implementation of the ICD-10 in an
organization, will affect more than the transactions of the
administrative. This process entails the following:
Consult
the current practice management system vendor
Consult
clearinghouses or billing service, if payers
were used.
Consult
payers about the possible changes in
the contracts as a result of implementing ICD-10.
Identify
potential changes to existing business process and work flow practice.
Identify
the needs for staff training
Carry
out test with trading partners
The budget for
implementation costs, including expenses for system changes, practice
business process changes, training, and resource materials.
Discussion
In the healthcare system, there are structural differences
between ICD-9 and ICD-10 that will make converting to the updated code
that is set complex. The length of
ICD-9-CM diagnosis codes is 3-5 digits in
length. The letters E and V are the only alpha used in ICD-9-CM. In ICD-10-CM,
the alpha codes are 3-7 numeric characters in length. The expanded characters
of ICD-10-CM codes are known to provide greater specificity so that to identify
the disease etiology, severity, anatomic site, and severity. Initially, the
additional characters in the ICD-10-CM codes allow for identification of the
body system, body part, root operation, and device involved in the procedure. In
addition, there are also a greater number of ICD-10 codes as compared to ICD-9 system. The expansion of ICD-9 number
diagnosis codes is from 14000 to 68000 in ICD-10-CM. The procedure codes
of ICD-9 increases from 4000 to 87000 in ICD-10-CM (Bowie, 2013).
Therefore, the
change in the length of the character requires system upgrades so that to
expand data fields for longer codes. The HIPAA upgrade version 5010
transactions must be completed before
implementing the ICD-10 set codes. The
date that was set for implementing the
5010 transactions is on January 1, 2012.
Recommendation
HIPAA recommends ICD-10-CM/PCS code
to covers entities that comply with their regulation by using the codes in
accordance with regulatory standards. Non-covered HIPAA entities implement
ICD-10-CM/PCS in the same way as it covers entities.
Specific data can provide better data for
a particular diagnosis trends, epidemic outbreaks, public health need, and
bioterrorism events. Therefore, precise codes will be supported by some
potential benefits through claims that are fewer
rejected.
Conclusion
In
conclusion, a regulation was passed that requires replacement of ICD-9 with
ICD-10. These practices are facing a staggering number of technology
requirements, including health information technology adoption, upgrading
administrative transaction, e prescribing and many others. Therefore, replacements
of ICD-9 with ICD-10 act as a significant change for the healthcare community. The adoption of ICD-10-CM/PCS does not required for
entities particularly which are not covered by HIPAA, such as casualty
insurance health plans and property, disability insurance programs, workers
compensation programs, state of agencies, and health data repositories such as
registries (Falen & Liberman, 2007).
References
Bowie, M. J. (2013). Understanding ICD-10-CM and
ICD-10-PCS: A worktext. Albany, N.Y:
Delmar.
Falen, T. J., & Liberman, A. (2007). Learning to code with ICD-9-CM for health information
management and health services administration. Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
Grider, D. J., & American Medical Association.
(2010). Preparing for ICD-10-CM: Make the transition manageable.
Chicago, Ill.: American Medical Association.
Optum Insight (Firm). (2012). ICD-10-CM and PCS coding readiness assessment: Measure
coding skills and focus your preparation efforts for ICD-10.
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