Strategies for ICD-10 take proactive approach

June 1, 2008

Most healthcare players agree that ICD-10 implementation will be expensive and resource-intensive. Yet opportunities abound to enable proactive organizations to become industry leaders with the new system.

Most healthcare players agree that ICD-10 implementation will be expensive and resource-intensive. That said, there are still opportunities that afford proactive organizations the chance to become industry leaders under the new system.

Implementation will reverberate beyond the core payer and provider community to any organization that submits claims or provides information to a health plan.

With 155,000 diagnosis and procedure codes in the system compared with 20,000 in ICD-9, the new system will allow far more granular, case-specific decision-making. Now is the time to develop effective implementation strategies. Health plans should create a multifunctional task force to:

The move to ICD-10 may not be on the same scale as HIPAA and Y2K, but it poses similar coordination problems between and within organizations, including third-party administrators, disease management organizations, employee benefit administrators, radiology benefit managers, and contractors such as durable medical equipment and home health agencies. While the IT department is an obvious affected party, many other functional areas will be affected including:

Communication breakdown

Many non-IT employees make daily decisions based on data from IT sources, and must soon face the discrepancy between the data they have and the data they actually need to make ICD-10-compliant decisions.

Any existing cross-functional communication struggles will make ICD-10 implementation even more complex, especially with CM/DM/UM. Policies are produced in text-not coded-form. Clinical staff translates this into CPT and ICD codes used in processing claims. ICD-10 will require much more refined – and challenging – coding to assure proper claims assessment, potentially exacerbating miscommunication between the policy and claims processing areas. This can raise administrative and claims investigation costs.

Furthermore, codes may be mapped differently based on the application. The claims department may handle mapping differently than, for example, those developing a disease analysis application. Organizations must decide whether they will take a universal approach or accept some variability.

Additional resources

ICD-10 implementation will require additional resources in every affected department. Accurately coding text-written policies will be an enormous undertaking.

Health plans that outsource certain functions (e.g., claims processing) must still evaluate remaining in-house functions, keep reimbursement processes consistent with policies, and be prepared to manage and consolidate disparate vendor data.

System updates will also require additional resources. Coding fields must accommodate seven digits as well as alpha and numeric characters. Conversion will not occur simultaneously industry-wide, so running ICD-9 and ICD-10 in parallel will be crucial.