On The Road to Coding Paradise (or Armageddon)

With the Department of Health and Human Services‘ release on Jan. 15 of the final rule for the ICD-10 code set and a supporting transaction standard, the U.S. is finally on the road to converting to the diagnostic coding system that most other advanced countries use. Bending to pleas from physician groups and insurance companies, HHS extended the deadline for complying with the ICD-10 rule from Oct. 1, 2011 to Oct. 1, 2013. The deadline for using the new 5010 transaction standard has also been postponed, from April 1, 2010 to Jan. 1, 2012.

Spokesmen for physicians and hospitals both welcomed the delay. Although the American Hospital Association earlier argued that there was no need for a longer transition period, George Arges, senior director of the AHA’s Health Data Management Group, acknowledges in an interview that it will provide a welcome breathing space because of the national economic crunch.

Robert Tennant, senior policy advisor to the Medical Group Management Association, expresses relief that the deadline was pushed back. But he notes, “It’s still going to be a significant challenge for physician practices to comply with these mandates. Even though they have more time, it’s still going to be expensive.”

Last fall, a report commissioned by the MGMA, the AMA, and several other medical organizations estimated that the switch to the ICD-10 coding system, which contains 10 times as many billing codes as the current system, would cost nearly $30,000 per doctor. That includes not only the cost of new software and training, but also the extra time that it would take doctors to document patient visits. Physicians are also concerned that the switchover will cost them dearly in terms of delayed claims payments during the transition period.

Every administrative and clinical information program used by the healthcare industry will have to be rewritten to accommodate ICD-10. Additionally, the new system will require providers and payers to use a new set of electronic transaction standards. To put this in perspective, Tennant notes, the current transaction standards were introduced in 2000 and still haven’t been completely implemented.

Most software vendors are just preparing to update their applications for ICD-10 and the 5010 transaction set. At this point, it’s unclear how long that will take—or how the industry will pay for it.

Both the MGMA and the AHA would like to see the Obama Administration and Congress designate some of the promised health IT funds to help providers cope with the ICD-10 transition. But, although the government is mandating the change, there’s no indication that this is under consideration. For example, the Senate Health, Education, Labor and Pensions Committee held a hearing Jan. 16 to hear testimony about how the government should promote health IT. This is an issue of more than academic interest, since about $20 billion has been committed for this purpose in Obama’s economic stimulus package. Yet none of the experts who testified before the committee were asked about ICD-10.