Notes from the RBMA Exhibit Floor: ICD-10

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imageOn October 1, 2013, CMS will flip the switch on ICD-10, and health care providers of all stripes will be required to submit claims to CMS using the new code-set-on-steroids. The number of diagnostic codes will multiply from 16,000 to 69,000; procedure codes will increase from 3,800 to 72,000. Every aspect of clinical and business operations will be affected.

Where better to get a sense of readiness and outlook than on the exhibit floor of the RBMA Spring Summit in New Orleans, June 5–8?

ICD-10 codes are alphanumeric and longer than ICD-9 codes, so before the big 2013 deadline, we have another deadline: January 1, 2012. Everyone who submits or pays a claim must transition to ANSI’s new 5010 transaction code set by January 1, 2012.

“Every time this happens, and a new transaction set change has happened many times, the same thing occurs—cash flow will see a hiccup, but it will level out,” notes Randal Roat, MMP. “We are recommending that our clients beef up their line of credit. Should something bad happen, have a plan B.”

But while the 5010 transaction code set may require a software upgrade and some changes in work flow, the move to ICD–10 entails much more in the way of changes in practice patterns.

McKesson’s Ron Jackson says physicians will be shouldering a significant share of the burden. For instance, if a patient has a fall and a physician is ordering head imaging, he has to notate where the fall took place.

Jackson recommends that practices begin preparing technologists now to assist. “Train your technologist to ask the right questions,” he recommends. “For CT lumbar, duration is required, level of pain. Training of techs needs to start now because it will go to a higher level when ICD 10 begins.”

Robert Kebbekus, Integrated Medical Partners, offers the example of the bee sting: Under ICD-9, a physician has the option of just one code to be paid; there are close to 100 diagnostic codes for a bee sting under ICD-10.

“There will be a great deal of pain, but being able to look at the specificity of ICD-10 can get at the heart of the quality of care,” Kebbekus believes. Such specificity has the potential to give providers the ability to cross-reference the financial and the clinical in a way that is not currently possible, he says.

A Messy Transition
If only it were as simple as adopting the 5010 transaction code set and transitioning to ICD-10. Unfortunately, providers will be living a double life for a while.

“It’s a switchover for CMS, but everyone else is going to have to have concurrent ICD-9 and ICD-10,” notes Julie Pekarek, Merge. “Rules need to apply to ICD-10, but you also are going to want to cross reference your ICD-9 and ICD-10.”

This—and the sheer volume of codes—is why experts are predicting a drop in coding productivity, which could have an impact on cash flow.

McKesson’s Jackson says the expert consensus is a 25% impact on coding productivity, but he thinks that is conservative. “We think a 25% decrease in productivity is for those people at the top of the game,” he says.

Nine months before launch in October of 2013, McKesson will start training their 423 certified coders. “If you are running too lean now, you are going to be running into a few hiccups, “ he advises.

But IMP’s Kebbekus believes that coders will not be enough: natural language processing will also be necessary to be able to properly code and understand the value of the ICD-10 charges information, particularly as they must be processed alongside ICD-9 indefinitely. “If you didn’t have some kind of an engine in front of you, the error rate would be so high that you can’t afford not to,” he says.

Zotec’s David Law reports that his software has been tested in all states where the company does business, but expects licensed clients to want to do their own testing, which will begin in September. The company will use regularly scheduled customer contacts to begin the education process.

“We will educate clients in our quarterly coding reviews and our monthly client service management meetings,” he says.

Taking a contrarian postion, MMP’s Roat believes physicians will embrace the new code set. “I’m optimistic about it,” he shares. “I think it will create work, but it will be accepted by the physician community better than other people think.

“So many times, we are coming to them with financial issues—they have to jump through hoops for reasons that add nothing clinically. At least ICD-10 falls within what they know.”

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