There were mixed emotions on April 1, as President Barack Obama signed into law the Protecting Access to Medicare Act of 2014. The lukewarm reception was largely because the law provides only a temporary delay in implementing a nearly 24 percent cut in Medicare physician payments stemming from the sustainable growth rate (SGR) formula, rather than offering a permanent fix to the problem. However, the legislation also provided for a one-year delay in implementation of the International Classification of Diseases, 10th Revision (ICD-10). The new compliance deadline for ICD-10 conversion is October 1, 2015. This is the second time in nearly two years that the ICD-10 compliance date has been pushed back.
This column addresses questions providers may have concerning the ICD-10 delay and offers resources for surgical practices to continue to prepare for the conversion.
Now that ICD-10 has been delayed, can my practice scale back its preparation efforts?
Although the ICD-10 transition has been delayed for another year, the American College of Surgeons (ACS) encourages members to use the additional time to become familiar with the new code sets, understand the differences between the International Classification of Diseases, Ninth Revision (ICD-9), and ICD-10, and prepare for how the switch may affect their practices. Health policy experts believe that the transition to ICD-10 will have widespread effects on operational processes across health care.
According to research released on February 4, by the Medical Group Management Association, practices lag in overall readiness for ICD-10 implementation. In fact, less than 10 percent of responding practices reported that they had made significant progress when rating their overall ICD-10 conversion, and 38 percent indicated they had not started to prepare. Research also revealed, among other data, that software upgrades or replacements are needed. More than 80 percent of respondents indicated that their software would require replacement or upgrades to accommodate ICD-10 diagnosis codes.*
What are the major differences between ICD-9 and ICD-10?
In 2003, the Health Insurance Portability and Accountability Act (HIPAA) identified ICD-9-Clinical Modification (ICD-9-CM) as the standard code set for reporting diagnoses and inpatient procedures. ICD is a diagnostic tool for epidemiology, health management, and clinical purposes. It permits the systematic recoding, analysis, interpretation, and comparison of mortality and morbidity data to track the incidence and prevalence of diseases and other health indicators around the world. Currently, ICD-9-CM includes both diagnosis and procedural codes.†
ICD-10 is expected to be an expanded code set, including additional information for ambulatory and managed care and injuries. It is expected to combine diagnosis and symptom codes to better define certain conditions, increase specificity through greater code length, and provide the ability to specify laterality.‡
What should providers do now to prepare for a smooth conversion?
The following are suggested preparation tips:
- Develop an organizational implementation strategy, including risk analysis and development of a timeline, checklist, and budget.
- Identify an organizational leader to facilitate the implementation process.
- Consider obtaining a line of credit. The conversion to ICD-10 could create a disruption in cash flow while practices become accustomed to the new system, and a line of credit could be useful in averting any associated financial worries.
- Participate in ACS ICD-10 training courses and purchase ICD-10 materials, such as the codebook.
- Review current clinical documentation practices in all practice settings (hospital, office, ambulatory surgery center, and so on) to determine whether they will be sufficient for ICD-10 coding. Work with the case manager and hospital documentation staff to ensure correct documentation.
- Reach out to external partners, such as the billing service, clearinghouse, practice management, electronic health record vendors, and hospitals, surgery centers, labs, and other affiliates to determine their progress in achieving the conversion.
- Ensure that external partners, which may have already created an infrastructure to support ICD-10 conversion after October 1, 2014, are able to accept ICD-9 for another year.
- Communicate with payors to be sure that they can receive and pay claims.
- Once all systems and external partners are compliant with ICD-10, conduct end-to-end testing before October 1, 2015. The Centers for Medicare & Medicaid Services may provide an opportunity for practices to participate in a demonstration project.
What ACS resources are available to help surgeons and their practices prepare for the ICD-10 conversion?
The ACS has added ICD-10 readiness sessions to its 2014 ACS coding workshops. The new sessions are aimed at helping surgical practices prepare for the 2015 conversion by providing specific ICD-10 examples of the most commonly cited conditions and educating surgeons and coders on how to locate codes in the ICD-10 manual. For a list of remaining 2014 ACS surgical coding workshops, visit the ACS website.
Surgical practices also may participate in a complimentary 45-minute ICD-10 webinar, Transitioning to ICD-10 Smoothly. This resource is provided by KarenZupko & Associates, surgical coding experts.
Lastly, the ACS ICD-10 Web page offers a factsheet, timeline, and much more.
- The CMS website, www.cms.gov/ICD10, and the CMS eHealth University, www.cms.gov/eHealth/eHealthUniversity.html
- The Healthcare Information Management Systems Society ICD-10 website, www.himss.org/resourcelibrary/TopicList.aspx?MetaDataID=1115
- The American Health Information Management Association ICD-10 website, www.ahima.org/topics/icd10
- The American Medical Association ICD-10 website, www.ama-assn.org/go/ICD-10
- The American Hospital Association Central Office ICD-10 website, www.ahacentraloffice.org/codes/ICD10.shtml
- The American Academy of Professional Coders’ ICD-10 website, www.aapc.com/icd-10/index.aspx
- Online tool for converting ICD-9 codes to ICD-10, www.icd10data.com
*Medical Group Management Association. New MGMA research: Industry coordination lagging; less than 10 percent of physician practices ready for ICD-10. Feb. 4, 2014. Available at: http://www.mgma.com/about/mgma-press-room/press-releases/2007-2012/new-mgma-research-industry-coordination-lagging;-less-than-10-percent-of-physician-practices-ready. Accessed May 7, 2014.
†World Health Organization. International Classification of Diseases. Available at: http://www.who.int/classifications/icd/en/. Accessed May 12, 2014.
‡American Medical Association. What you need to know about the upcoming transition to ICD-10. Available at: http://www.azmed.org/ckfinder/userfiles/files/icd-10-transition.pdf. Accessed May 12, 2014.