“The transition to the International Classification of Diseases-10th Revision, Clinical Management coding system is more than a compliance exercise—it is a transformational event.”
In fact an Oct. 21 HIMSS/WEDI ICD-10 National Pilot Program Outcomes Report also warns that a recent test of professional coders only achieved a 63% accuracy rating when submitting ICD-10 codes.
While the transition to ICD-10 will impact everyone working in the healthcare continuum—from providers to payers and vendors—physicians have the most to lose. If claims are not submitted accurately, physicians simply won’t be paid. With less than a year until the one-day ICD-10 conversion on October 1, 2014, a physician’s ultimate life preserver is going to be planning and training, says Shari Erickson, MPH, vice president of government and regulatory affairs for the American College of Physicians.
“It’s time to kick it into gear,” Erickson says. “If you aren’t able to bill with ICD-10 codes next year, it is not just a little cut in payment. It is a 100% cut.”
Why so complicated?
ICD-10 greatly increases the specificity with which diagnoses are reported. The number of outpatient diagnostic codes will increase from around 13,000 to more than 68,000.
For medical practices, transitioning to the new coding system will require training for coders, billers, and providers in the documentation requirements, as well as changes to billing software and superbills. A 2008 study prepared by the consulting firm Nachimson Advisors LLC estimates the conversion costs will range from slightly more than $83,000 to as high as $2.7 million, depending on the size of the practice. A 2006 study prepared for America’s Heath Insurance Plans, the trade association for commercial payers, predicted the cost to the nation’s healthcare system as a whole will range from $3.2 billion to $8.3 billion.
Matthew Finneran, MD, a family medicine and geriatrics practitioner in Wadsworth, Ohio, has already started trying to get into the habit of coding with greater precision. Finneran says that preparing for the transition has made him and members of his staff pay more attention to the codes they use now. They are trying to input codes as accurately as ICD-9 allows, carrying them to the second decimal point whenever possible. “We are making the extra effort to capture all the right codes so we can identify the complexity of visits, even though we are not getting paid for it yet,” he says.
Finneran believes that making the transition is everyone’s responsibility, which is why his entire team—which includes two full-time physicians, two part-time physicians, a nurse practitioner, and about 15 support staff—is working on understanding ICD-10 so they can help the practice’s biller/coder do her job better.
Practices that have not already gotten started on ICD-10 preparations need to get busy. “If you ignore it, you are only hurting yourself. It will be a 1-day switchover. There will be no transition. If you aren’t ready, you won’t be paid,” he says.
But since his practice is well on its way, he has another concern: Will his payers be ready? “Are they going to be able to pay me in a timely way? I have my doubts, especially Medicare. As a small practice, I don’t have a hospital to subsidize my cash flow or help me pay my employees,” he says. Some experts are recommending that practices secure a line of credit ahead of the transition that they can draw on if a problem with the ICD-10 transition halts their cash flow temporarily. “It would be prudent to take out a credit line equal to about 5% of the total reimbursement for the year for the practice,” says Michael F. Arrigo, CPHIT, CPEMR managing partner of No World Borders, a healthcare management and information technology consulting firm.
However, Finneran says even that wouldn’t calm all of his fears, because credit lines have costs that he would probably have to shoulder alone.