How to Prepare for ICD-10 Coding, Software Revisions

Or so it is hoped and expected.

The law itself will require only that providers and payers implement the system for purposes of billing. But the new system can and should be used to spur innovation not only in efficiency in billing and payment procedures but also in medical treatments.

It can detect problematic drugs and medical devices and can indicate necessary follow-up research or investigation, generally or specific to that patient. And it can assist medical researchers. A big advantage of ICD-10 is that nations all over the world are implementing it—some already have, and several more are on schedule to complete their transformation before the United States does—so providers, payors and researchers in most of the industrialized world will be able to review data. (The data will not identify the patient to anyone outside the access circle currently allowed under HIPAA, so there will be no impact on patient privacy.)

Implementation cannot be done within a few months. Nor is it expected that the deadlines will be extended again. They already were, by two years. It is critical that providers and payors that have not begun the transition do so now.

The Centers for Medicare and Medicaid Services (CMS) estimates that it will take the average organization between 18 and 36 months to make the transition from ICD-9. In early 2009 a four-year window for compliance was provided—a window that has now shrunk to little more than two years.

The systems requiring upgrade or replacement include claims payment, adjudication, and decision support systems; systems for the presentation of clinical content for the support of plans of care; reporting programs; and external interfaces.

Health and Human Services (HHS) estimates that implementing this change will cost providers $3 Billion, with costs running into 2017. The health insurance trade organization America’s Health Insurance Programs (AHIP) estimates that the implementation costs to payors will range from $38 million for small health plans (less than one million members) to $11 million for large plans (more than 5 million members). AHIP estimates that the total system-wide cost for insurers is likely to be in the $2-3 billion range.

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