Chicago — The mandatory implementation deadline for the International Classification of Diseases, 10th Revision (ICD-10) coding system has been moved back from Oct. 1, 2014, to Oct. 1, 2015, easing pressure on clinicians who have not yet started the change.

But this may be the only opportunity to catch up. For clinicians who continue to delay, there is strong potential for chaos and perhaps lost income from a poorly planned transition.

“It is fairly simple: If you are not billing with ICD-10 codes for services provided on or after October 1, 2015, you will not be paid,” said David Harano, MBA, executive director of Gastro One, a large gastroenterology practice in Germantown, Tenn. Speaking at 2014 Digestive Disease Week (DDW), Mr. Harano warned that implementation of ICD-10 codes “will cost you” in more staff hours for billing and perhaps less time with patients. All the potential problems are likely to be magnified with a head-in-the-sand approach, he added.

“The problem is putting it on the back burner,” agreed Rhonda Buckholtz, CPC, CPMA, vice president for ICD-10 education and training at the American Academy of Professional Coders (AAPC), in Salt Lake City. According to Ms. Buckholtz, the codes are largely limited to process adjustments. Training is required, but productivity loss can be minimized with adequate planning and testing. “Studies suggest that practices can be up to speed in six weeks,” Ms. Buckholtz said.

ICD-9 has been in use for approximately 30 years; it employs five-digit codes to record clinical tasks. With up to seven digits, ICD-10 codes have more room to capture meaningful use and quality metrics.

The ICD-10 system has roughly five times the number of codes as its predecessor. For example, the handful of ICD-9 codes for the diagnosis and treatment of Crohn’s disease has been expanded to 25 codes, with capability to capture clinical information, Mr. Harano said. Single codes for diagnosis and treatment of conditions such as hemorrhoids have been expanded to capture such characteristics as grades of severity.

When the ICD-10 codes were first released, news stories mocked examples of the most obscure descriptions, such as V91.07xD, which describes burns acquired from water skis on fire. The transition is more evolutionary than revolutionary because the codes, although more complex, largely perform the same function. It is a matter of adjusting to the new nomenclature. According to Ms. Buckholtz, “consultants are not essential” for a successful upgrade.

One advantage of ICD-10 over ICD-9 is that is a better way to capture data on value-based health care. “If you are already focused on quality health care, the ICD-10 is going to be a more natural progression,” Ms. Buckholtz said, referring to the growing number of electronic medical record (EMR) systems that capture quality metrics. One example has been the widespread efforts to amend EMR for colonoscopy in order to capture performance benchmarks independent of steps relevant to billing. This is consistent with the premise of the new ICD-10 codes.

From the practical perspective, however, preparing for the change may be the biggest burden. The training alone for physicians and staff may be expensive, and it would be wise for every individual practice to conduct extensive testing before launching the full transition. Ironing out problems well before Oct. 1, 2015, is essential to prevent revenue flow disruptions, Mr. Harano said.

“A line of credit may be important to avoid any cash flow issues if there are hiccups in the process,” said Mr. Harano, who added that he believes the new deadline will be enforced.
—Ted Bosworth

“Reprinted with permission from Pain Medicine News. All rights reserved.”