Sixteen years ago, The Health Insurance Portability and Accountability Act, commonly referred to as HIPAA became federal law. While the whole country is familiar with the privacy provisions of the act, outside of the healthcare industry few know that it also calls for standardization of health care information that includes standards for provider identifiers, electronic claims submission and code sets. The requirement for code sets coupled with standards for electronic submission are what began the discussion of conversion from The International Classification of Diseases Version 9 (ICD-9) to Version 10 (ICD-10). The United States Department of Health and Human Services has now set October 1, 2013 as the deadline for conversion. In healthcare industry jargon, International Classification of Diseases is almost always called by its acronym ICD-version.
The original planned date of implementation for ICD-10 was October 1, 2013. Heavy lobbying by industry groups for a two year delay ultimately brought a compromise with the implementation postponed by one year to October 1, 2014.
However, the most provider organizations continue to lobby for a later implementation date with some even suggesting that ICD-10 be skipped and the country wait until ICD-11 is released.
Proponents of not allowing further delays have some powerful reasons that demand attention. These have been identified by The Centers for Medicare & Medicaid Services (CMS) to include:
- Improving payment systems and reimbursement accuracy
- Measuring the quality, safety and efficacy of care
- Conducting research, epidemiological studies, and clinical trials
- Setting health policy
- Monitoring resource utilization
- Preventing and detecting healthcare fraud and abuse
However, those seeking to delay implementation also have good arguments. These are, according to CMS:
- The ongoing transition to Version 5010—a necessary precursor to ICD-10 adoption, which has also been delayed
- Hospitals, health systems, and physicians’ current efforts to comply with Meaningful Use Stage 2 requirements
With many in the health industry seeking to further delay implementation of ICD-10 the question the industry is struggling with is: Should such a delay take place?
Clearly, the transition to ICD-10 will be among the greatest changes ever in the business aspect of the healthcare industry. It has the potential to have a major impact on revenues streams and the way providers and insurance companies operate.
The American Medical Association also is claiming cost as a barrier to conversion claiming an estimate of a minimum of $83,000 for a small group to make the change all the way to nearly $3 million for a very large practice to make the change. What is behind these numbers has not been identified.
Many providers have begun the process of conversion and have begun discussions with software vendors, third party billing companies and are in the process of planning for training as the implementation date comes closer.
The industry has had ample time to prepare and their argument that having to do the conversion of ICD-9 to ICD-10 is also coping with implementation of EHR, e-prescribing, the meaningful use of electronic health records and the Physician Quality Reporting System so a delay isn’t without merit.
As the change will increase the number of codes in use from around 14,000 to well over 60,000 codes the initial AMA proposal of a two year delay is not unreasonable – if for no other reason than the learning curve will be enormous for all players. Accordingly, the delay, just due to the enormity of the change should be extended one additional year. As many would like to run parallel testing for a while, those providers ready to use iCD-10 should be allowed the option of running parallel coding systems or switch to ICD-10. However, if there is a delay in implementation of Version 5010 for electronic data interchange than the ICD-10 conversion should be extended for a period of 18 months after the implementation of Version 5010.
Postscript
The Centers for Medicare & Medicaid Services (CMS) announced a one year delay of the implementation of ICD-10 today, August 24, 2012. Many doctors and administrators feel this still isn’t enough time.
Alan E is a freelance writer/editor with a background writing about healthcare issues.