Thursday, March 03, 2011

ICD-9, ICD-10: Whatever it takes...

Recently, we were alerted to a potentially useful "widget" which empowers health care consumers in making informed decisions. Kate Hersch wrote to tell us about a tool that gives consumers "ICD-9 code information in an easy to use, searchable widget."

The ICD-9 tool is designed to enable health care consumers to quickly and easily determine how and why their claims are paid (or denied). As the site notes:

"Many insurance claim denials are due to human error in recording the correct ICD-9 code in medical billing forms."

We've written before about these ICD-9 codes, but now there's a new kid on the block:

"U.S. health care providers and health plans have two years left to adopt a new federally mandated system of medical coding ... there is no federal funding for the computer upgrades needed to accommodate the new medical coding."

First, one wonders if HHS Secretary Shecantbeserious will also be selling, er, handing out ICD-10 waivers?

Be that as it may, the "new" codes aren't really "new new," as our resident Medical Office Manager Kelley Beloff graciously explains:

This article is outlining the next new cost for all of medicine in America. Physicians, hospitals, etc, are paid based on two sets of codes. The CPT (Current Procedure Terminology) codes (which are owned by the AMA) specify what procedure was done. For example, code 99213 is a mid-level, established visit usually lasting 15 minutes. However, to be paid, the physician must also include a diagnosis code called an ICD (International Classification of Diseases) code. Currently, America is using the ICD-9, or the 9th revision. The rest of the western world is using the ICD-10, or the 10th revision.

The ICD-10 adds thousands of new codes to the diagnosis arsenal and the codes are formatted differently. Why would this be a problem? Because physicians are spending hundreds of thousands of dollars, mandated by the HITECH Act, to convert their offices from paper to Electronic Medical Records, which must be done by 2014. All of these EMR'S are programmed to read ICD-9 codes, not ICD-10 codes. The set date for transition to the ICD-10 format is October of 2013. The cost to change all the forms, templates, and computer systems used by America's physicians will be in the millions.

When I went back into the medical field in 2003, the transition to the ICD-10 had already been set and passed. In the years since I can recall at least three different set dates for the transition. Each date has passed without the ICD-10 being implemented. In my opinion, physicians will rebel if they have to pay twice for their offices to be compliant with government regulations: first to install the EMR and then again to reformat the EMR they purchased 12 months before. I believe that this country will go metric before we go ICD-10.

Thanks, Kelley!
blog comments powered by Disqus