The Department of Health and Human Services has released the long-awaited ICD-10 codes and extended the compliance date for adopting them from October 1, 2011 to October 1, 2013.
The codes and compliance date, issued in a January 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.
HHS also released an updated X12 standard, Version 5010, for certain electronic healthcare transactions. According to HHS officials, Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization and other administrative transactions.
Outgoing HHS Secretary Mike Leavitt said the new regulations "will move the nation toward a more efficient, quality-focused healthcare system by helping accelerate the widespread adoption of health information technology."
According to Leavitt, adoption of the ICD-10 code set is expected to support Medicare's value-based purchasing initiative and antifraud efforts and will allow the United States to compare its data with international data. The United States is one of the few developed countries not using ICD-10.
The American Academy of Professional Coders, American Clinical Laboratory Association, American College of Physicians, American Medical Association and Medical Group Management Association all supported the delay, while the American Health Information Management Association was not so pleased.
The extension will mean "more years without the data needed to make intelligent data-driven decisions related to all aspects of healthcare," AHIMA officials said. Yet, despite the compliance extension, providers should start now to make the transition, they advised.