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TOPIC: ICD-10 debate rages on

HIM Connection, October 28, 2003

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TOPIC: ICD-10 debate rages on

Conflicting testimony at the most recent quarterly meeting of the National Committee for Vital Health Statistics (NCVHS) furthered the debate over implementation of ICD-10. Two organizations supported the replacement of ICD-9-CM with ICD-10-CM, and two opposed it.

Representatives from the American Hospital Association, and the American Health Information Management Association (AHIMA) 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 dont 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:

1. More accurate payment for new procedures. More codes will be available, allowing for more detailed descriptions of medical conditions and treatments.

2. Fewer rejected reimbursement claims. Only one-in-five claims makes it through the payment system without questions and results in full payment, Libicki said.

3. 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.

4. Better understanding of the efficacy of new procedures. Not all new procedures will be able to have their own codesonly those with proven, understood results will earn one.

5. 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.

This week's HIM Connection was adapted from an article in Medical Records Briefing. Click here for more information or to order.

Sincerely,

Kate Alvarez
Editorial Assistant
kalvarez@hcpro.com

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