ICD-10 Sneaks Up

From the American Health Information Management Association’s ICD-10 meeting in Washington:

Like any profession, medical billers have their own “in” jokes, as was evident at today’s conference on the ICD-10 (which the attendees called the “I-10”), the newest incarnation of the diagnosis code set. “What does I-10 mean to me? Hypertension,” said Dave Hochheiser, vice president of data analytic solutions for Ingenix Consulting, in Eden Prairie, Minn. Why is that funny? Because under the new ICD-10 codes, “I10” is the code for hypertension.

OK, maybe that’s a bit obscure. But the discussion during the rest of the meeting was all brass tacks, and the message was: Start thinking about ICD-10 now, even though it won’t be sneaking into a computer near you until 2013.

Image courtesy Flickr Creative Commons user mlsj

Image courtesy Flickr Creative Commons user mlsj

At first glance, ICD-10 might not seem that big a deal – after all, you’re just replacing one diagnosis code with another. Well, not exactly.

Since one purpose of ICD-10 is to get more specific, the new codes have a lot of permutations. For example, the current version of the codes, known as ICD-9, includes exactly one code for a simple laceration of the finger, 883.0. ICD-10, on the other hand, offers 270 choices for the same diagnosis, depending on which hand was involved, which segment of which finger, whether it involved a foreign body, and so forth, noted Robert Burleigh, past president of the Healthcare Billing & Management Association. All that precision will be great for future health care researchers to mine data from, but for physicians and hospitals who are just trying to get paid, it can be a real nightmare to implement.

Every commercial insurer out there will be trying to figure out how to apply the new codes. Then there’s Medicare, which will have to rewrite all its local and national coverage decisions since they are all written using ICD-9 terminology, Mr. Burleigh said. And Medicare Advantage providers also will be affected, because reimbursement rates to providers are increased based on the patient’s severity of illness as determined by diagnosis code. Not to mention the problem of fitting all the new diagnosis codes onto a superbill.

Of course, getting paid in the ICD-10 era will depend on having a computer system that knows how to deal with ICD-10 codes. Providers need to make sure that ICD-10 capability is specified in their contracts with vendors, and include penalties if deadlines are missed, said Mr. Burleigh. Let the buyer beware.

–Joyce Frieden

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