Eli's Rehab Report

ICD will leap from 17,000 to 155,000 codes in 2011.

Feeling confident about your diagnosis coding? Get ready to shake things up -- it will soon be time to master a brand new incarnation of the system: ICD-10. And if you're hailing from an inpatient setting, a slew of new codes could throw the prospective payment system mastery you've gained for a loop.

The good news: The proposed implementation date for the new system isn't until 2011, CMS revealed in a proposed rule issued on its Web site Aug. 15. And the agency has good things to say about ICD-10.

"The greatly expanded ICD-10-CM code sets will enable HHS to fully support quality reporting, pay-for-performance, bio-surveillance, and other critical activities," noted Health and Human Services Secretary Mike Leavitt in a press release.

ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses, CMS explained. Nearly 140 countries already use the new ICD-10 system. And the agency doesn't want to wait any longer. "We recognize that the transition to ICD-10 will require some upfront costs, but each year of delay would create additional costs," said CMS acting Administrator Kerry Weems.

But not everyone is as optimistic as CMS. There are "significant risks" with pushing the implementation date too quickly, according to a Sept. 22 e-mail the American Academy of Professional Coders sent to members. Major changes include an increase in the number of diagnosis codes -- from approximately 13,000 ICD-9 codes to 68,000 ICD-10 codes. In addition, inpatient facility coders will be faced with an approximate 87,000 PCS codes.

Don't miss: At the same time, the industry will see an updated version of HIPAA electronic transaction standards, Version 5010. The currently adopted standard, Version 4010/4010A1 of the American Standards Committee X12 group, cannot accommodate the much larger ICD-10 code sets, CMS explained.

Bottom line: All of this adds up to lots of time and money for both providers and payers to make the transition, AAPC indicated in its note. Some foresee issues so dire that they are rallying protests against ICD-10 implementation -- period.

"The expense for small and even medium practices could be so overwhelming, they'd need to close or sell out," says Quin Buechner, MS, M. Div, ACS-FP/GI/PEDS, CPC, CCP, CMSCS, of ProActive Consultants in Cumberland, Wis., who believes that ICD-10 isn't even necessary for reporting clinical work. "This [change to ICD-10] is a call for you to register a protest with your congressperson."

Others, however, aren't as worried. "We estimate two days of training to learn ICD-10," says Sue Bowman, RHIA, CCS, director of coding policy and compliance for American Health Information Management Association. And training for ICD-10-CM probably won't eat up any additional money, Bowman claims. Coders already require continuing education to keep up with changes, so money from that budget can be used to train for ICD-10.

However large or small the impact will be, keep the technical transition factors in mind now. "Regardless of when ICD-10 will become effective, the government is not likely to be ready to manage change required by Medicaid offices and the MACs (Medicare Administrative Contractors)," predicted Joanne Byron, LPN, BSNH, CHA, CMC, CPC, CPC-I, MCMC, PCS, CEO of the American Institute of Healthcare Compliance Inc (AIHC), in an e-mail to members.

Plus: Major insurance companies aren't likely to upgrade their software systems in time, Byron added. So you should anticipate problems with processing claims. "Many practices and facilities are likely to require a new practice management system if the current system cannot be supported to accommodate ICD-10."

That said, AIHC recommends talking to your practice management software company now. Ask whether your practice will require a new system or if your current software accommodates the additional characters needed for ICD-10.

Tip: You can actually upload ICD-10 now, Byron said. "These codes are available from the Centers for Disease Control (CDC) Web site." That's www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm.

Note: To read the proposed rule for ICD-10, see http://edocket.access.gpo.gov/2008/E8-19298.htm. To read the proposed rule on HIPAA electronic transaction standards, see

http://edocket.access.gpo.gov/2008/E8-19296.htm.