ICD-10 debate rages on
HIM Connection, November 24, 2003
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ICD-10 debate rages on
Cost, training, system upgrades among factors
Representatives from the American Hospital Association, the American Health Information Management Association (AHIMA) and presented myriad benefits of ICD-10 and the increasing limitations of ICD-9. Meanwhile, representatives from the American Medical Association (AMA) and the Health Insurance Association of America claimed that the costs of implementing a new coding system are prohibitive. The AMA stands to lose millions of dollars if ICD-10-PCS is implemented in place of CPT, since it is the proprietor of the CPT system.
ICD-10 opponents say payers and providers don?t have the technical readiness to switch to the seven-character alphanumeric system. Dr. Martin Libicki, senior policy analyst for the RAND Corporation, presented a cost-impact study conducted by his organization for AHIMA that estimated the cost of implementing ICD-10-CM and ICD-10-PCS simultaneously. These costs, which would include coder training and system upgrades, would fall between $425 million and $1.5 billion the first year, with an additional $5 million?$40 million every year thereafter.
Libicki listed the following benefits of implementing ICD-10:
- More accurate payment for new procedures. More codes will be available, allowing for more detailed descriptions of medical conditions and treatments.
- Fewer rejected reimbursement claims. ?Only one-in-five claims makes it through the payment system without questions and results in full payment,? Libicki said.
- Fewer questionable claims. Libicki acknowledged the initial increase in possibility of fraud, due to unbundling, upcoding, etc., but said there would be fewer gray areas in the long-term.
- Better understanding of the efficacy of new procedures. Not all new procedures will be able to have their own codes?only those with proven, understood results will earn one.
- Improved disease management. The new coding system allows for better tracking of such common conditions as diabetes and high blood pressure.
The cost-impact study recommended implementing the two coding systems simultaneously so that the health care industry only has to go through training, system upgrades, testing, and other transition challenges once. ?Expandability is a very critical aspect for Medicare,? said Tom Gustafson, director of the Purchasing Policy Group, Center for Medicare Management at the Centers for Medicare & Medicaid Services (CMS). He pointed out that regular updates, such as local medical review policies and coding edits, are ongoing, and should be considered when attempting to estimate ICD-10 implementation costs.
The functions of the seven characters of ICD-10-PCS:
1st?section (medical or surgical)
2nd?body system
3rd?root operation
4th?body part
5th?approach
6th?device used
7th?qualifier
Medicare needs greater precision in payment rates, he added. ?We started with 400 DRGs [diagnosis-related groups], and we now have more than 500. Medicare is under regular pressure to improve the structure of DRGs.? CMS is currently conducting its own impact studies, which it may present at the [Department of Health and Human Services] Subcommittee on Standards and Security meeting at the end of October.
Nelly Leon-Chison, RHIA, director of coding and classification for the AMA, and Sue Prophet-Bowman, RHIA, CCS, director of classification and coding for AHIMA, presented the results of the ICD-10 field testing conducted this summer.
Of the 169 participants in the testing, 83.6% support migration to ICD-10-CM. Of those, 78.6% said it should be implemented within three years.
?There?s a real cost of doing nothing,? said Linda Kloss, RHIA, president and CEO of AHIMA. ?The manageability of data is deteriorating. We?re paying the price in loss of productivity and innovation. Vendors would build new tools if they knew what code set to build around. Fifty-thousand hospital coders continue to move paper records from one side of their desk to the other. We encourage the committee to make a decision and move forward.?
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