If you aren't working on ICD-10 now, you're already behind schedule

April 1, 2010

The rapidly approaching shift from ICD-9 to ICD-10 is a massive system overhaul that many have underestimated.

ALTHOUGH HEALTHCARE is a tough business, some issues transcend market competition. That is certainly the case with the rapidly approaching shift from ICD-9 to ICD-10, a massive system overhaul that many have underestimated. The federal government settled for a final compliance date of Oct. 1, 2013, two years later than it originally proposed because of pushback from the industry.

Because the overhaul will have such far-reaching effects, large-scale collaboration is critical to making it work, according to Rich Cullen, managing director of interplan programs for the Blue Cross and Blue Shield Assn. (BCBSA).

That's why BCBSA and other health plans are working with the American Hospital Assn., the American Medical Assn., and government agencies to ensure the benefits of ICD-10 conversions are realized.

According to Joe Nichols, MD, medical director for Edifecs, a healthcare IT firm based in Bellevue, Wash., the ICD-9 code set contains a total of 32 codes for a fracture of the radius, for example. Under the new ICD-10 set, there are more than 1,700 codes for the same injury.

Generally, industry experts agree that ICD-10 codes ultimately will deliver on the promise of greater insight into providers' decisions to perform specific treatments and procedures, and a smoother path toward automating healthcare transactions. But just because it's the right thing to do doesn't mean payers or providers are motivated to make the change. Implementation could take years, and the Department of Health and Human Services (HHS) is expecting error rates on filed claims to rise from the typical 3% seen after past updates to as much as 10% after ICD-10 conversion.

"While we all look forward to realizing the benefits ICD-10 will bring, we first have to get the codes implemented and working for all stakeholders," says Russ Thomas, president of Availity, a health transactions network based in Jacksonville, Fla. "The migration to ICD-10 is not a simple upgrade. If we only had to expand field lengths to support the new format, that would be relatively straightforward. But that is not the case. Among many things, there are translation issues to deal with."

Understanding the increased specificity provided by ICD-10 and applying it appropriately will require an enormous amount of training at all levels of the healthcare supply chain, he says. HHS estimates implementation costs at $1.64 billion industrywide, including $356 million in training costs.