Health Information Compliance Alert

Don't wait until the last minute to refit your systems.

You're busy updating your superbills and EMR systems to incorporate the ICD-9 2009 changes -- but you only have three years left until the ICD-9 series is replaced by the new, revamped ICD-10 codes, according to a recent HHS announcement..

The Dept. of Health and Human Services (HHS) delivered a whammy in August with its announcement that ICD-10 codes aren't too far away. On Aug. 15, HHS announced its proposal to replace the ICD-9 codes with the ICD-10 series effective Oct. 1, 2011 (2012 ICD-10 code set).

The plan: Not only would the new code set completely overhaul your claims systems, software and superbills -- but it could require significant staff training.

Here's why: The ICD-9 code series includes 17,000 codes. The ICD-10 code set, however, contains more than 155,000 codes around if it's implemented as HHS hopes it will be.

Many medical practices were surprised by the news of the impending ICD-10 implementation, despite the fact that CMS has been building the new code set for years.

"We've been thinking of ICD-10 as this far-away prospect that may never take hold," says Heather Corcoran with CGH Billing. "The new announcement sort of brings us back to the reality that this will indeed take effect."

"What this means is massive changes to all computer bases and programming and charge masters and codes. Nothing [presently] in existence can be used. Coders will need to be retrained and retested for certification," says Quin Buechner, MS, M. Div, ACS-FP/GI/PEDS, CPC, CCP, CMSCS of ProActive Consultants in Cumberland, Wis. "The expense for small and even medium practices could be so overwhelming, they'd need to close or sell out." During the transition, computer systems will have to maintain ICD-9 for services before 10/1/2001 and ICD-10 for all services after 10/1/2011. This makes Y2K look like a walk in the park, experts say.

"We recognize that the transition to ICD-10 will require some up-front costs, but each year of delay would create additional costs, both because of the limitations of ICD-9 and because of the need to employ the greater precision that ICD-10 codes provide to support value-based purchasing of health care and other initiatives," said CMS Acting Administrator Kerry Weems in a statement.

Speak your mind: HHS is seeking comments on the proposed ICD-10 code set and transaction standards. To read more, you can visit the CMS Web site at http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp.

"Now is the time for action," Buechner says. "ICD-10 is expensive and not clinically necessary for professional services. It is possibly of use in the hospital setting for procedure coding but that is open to debate. The so-called 'improvement' from 17,000 codes to 155,000 codes is not an improvement at all when one thinks about it. In ICD-9 we do not use all the codes available for clinical work partly because the split down to the most minute and minuscule variation of a disease process is really not necessary for clinical work. This is a call for you to register your protest with your Congressperson."