In January of this year, the Department of Health and Human Services released the long-awaited ICD-10 codes and extended the compliance date for adopting them from Oct. 1, 2011 to Oct. 1, 2013.
The codes and compliance date, issued in a Jan. 15 rule, will give providers an additional two years to prepare for the transition from the 30-year-old ICD-9 set, which experts are contending will be costly and time-consuming.
According to a study initiated by a broad group of provider organizations and conducted by Nachimson Advisors, the cost for a 10-physician practice to implement ICD-10 is estimated at more than $285,000. This includes the cost of training expenditures, new claim forms software, business process analysis, practice management and billing software upgrades, increases in claim inquiries and reduction in cash flow and increased documentation costs.
For a three-physician practice, the cost to implement ICD-10 is estimated at $83,290, the study said. For a 100-physician practice, the cost is more than $2.7 million.
Experts from the American Academy of Professional Coders say the transition to ICD-10 will require doctors to learn a more extensive way of documenting their work, or they could face losing reimbursements.
John Halamka, MD, CIO of CareGroup Health System and Harvard Medical School, said the ICD-10 code set allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures, a significant expansion of the 17,000 codes available in ICD-9. Providers can best prepare by improving electronic clinical documentation, he said.
“The granularity of ICD-10 requires precise clinical documentation,” according to Halamka. “Unstructured paper-based notes are unlikely to enable coding beyond the most general code for each diagnosis.”
On Aug. 31, the Centers for Medicare & Medicaid Services issued a new fact sheet on ICD-10.
According to the fact sheet, diagnosis coding under the ICD-10-CM system will use three to seven alpha and numeric digits and full code titles, but the format is similar to ICD-9-CM. The new procedure coding system will use seven alpha or numeric digits while the ICD-9-CM coding system uses three or four numeric digits.
The CMS fact sheet says ICD-10-CM/PCS will improve the ability to measure healthcare services, increase sensitivity when refining grouping and reimbursement methodologies, enhance the ability to conduct public health surveillance and decrease the need to include supporting documentation with claims.
It will also provide codes to allow comparison of mortality and morbidity data and will provide better data for identifying fraud and abuse and conducting research, according to CMS.