ICD-10: Providers & Payers – Be Prepared

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January 29th, 2014

ICD-10As of October 2014, the latest version of the International Classification of Diseases – ICD-10 – will take effect, requiring healthcare professionals to implement a series of complex and in depth changes to their medical coding process and compliancy. ICD-10 will increase the current code database under ICD-9 from 17,000 procedure codes to 141,000. Prior to the update, healthcare professionals are now responsible for ensuring their systems, software, and staff will be fully prepared for ICD-10’s implementation.

Most of the industry has already begun voicing their concerns over the rapidly approaching deadline and the amount of work it will take to implement ICD-10. CMS has stated the deadline will not be moved after moving it once before.

The US is the last remaining industrialized country to make the shift from ICD-9 to ICD-10 and should look to its global partners for assistance in its implementation. Across Europe and Canada, ICD-10 was seamlessly introduced in phases however, there were far fewer codes that were added or changed.


The change is intended to document public health records to a higher level of detail, allowing healthcare professionals to track health patterns and monitor outbreaks of sickness. To achieve this, it will require hours of preparation and millions of dollars in spending from healthcare professionals if it is to be fully effective.

Updating and testing software to accommodate the changes will be extremely complex and could cost the industry up to $1.6 billion in the form of staff training, lost productivity and system overhauls. Furthermore, with no central authority governing the implementation or testing of ICD-10 software, preparations may become strenuous.

For many in the healthcare industry, these costs will be a major factor in how quickly or how feasible it may be in implementing ICD-10. Hospitals operating within smaller profit margins or low revenues as well as many private-practicing physicians may turn towards consolidation to balance the costs.

WEDI & The ICD-10 Implementation Success Initiative

One of the key consultants to CMS and HHS during the change from ICD-9 to ICD-10 is WEDI, the Workgroup for Electronic Data Interchange. Recently, WEDI conducted a survey across 196 medical providers, 98 health plan administrators and 59 tech vendors. The respondents gave their opinions and stated their level of preparedness for the upcoming ICD-10 implementation.

Of the respondents, providers seem to be the most behind with their preparations. 8 out of 10 providers indicated they have not completed the necessary system and software changes in order to be ready for testing. Furthermore, 1 in 4 health plans still need to conduct impact assessments. Health plan administrators seem to be the most ready, 1 in 3 are expected to begin or have begun external data testing. Vendor preparedness will play a large role in determining the length of testing periods and could disrupt other parties’ implementation process.

Most of the impacted entities are concerned with the effects on coding and documentation procedures. Medical coders will have to learn a large set of new codes and definitions that require a high level of specificity. For in-patient coders, they will have to learn two new code sets: ICD-10-CM for diagnosis, and ICD-10-PCS for procedures. As a result, ICD-10 will shift industry focus towards improving clinical documentation. CMS officials have indicated that the improvements to clinical documentation and more specific coding definitions will lead to a smoother payment process, fewer delays or discrepancies with data, and less denials. But lost-productivity still remains an underlying factor for many.

A decrease in productivity is to be expected during implementation and in the months following ICD-10’s go-live date – October 2014. Looking at the countries that have already changed to ICD-10, it could be estimated that it will take 6 months to return to normal productivity status. The loss of productivity will result from the time taken to train staff, adapt to new processing procedures, an increase in enquiries from coders, and an increase in billing inquiries from payers.

Many of the respondents have suggested they will concentrate on clinical document improvement for high-revenue diagnoses, coordinating software updates and installations, and data testing and staff training as soon as possible.

For industry professionals seeking assistance with ICD-10 implementation, the ICD-10 Implementation Success Initiative has opened an online forum where WEDI & CMS staffers have been assigned to resolve any issues.

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