Health Information Management

Survey: ICD-10 delay impeded implementation progress for many

APCs Insider, October 10, 2014

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By Steven Andrews, Editor
The Congressionally mandated ICD-10 delay this spring gave providers an extra year to train and test for the transition, but also delayed implementation progress for a majority of providers, according to the latest Workgroup for Electronic Data Interchange (WEDI) ICD-10 readiness survey.
Two-thirds of the 324 providers, 87 vendors, and 103 health plans surveyed reported slowing down or putting implementation plans on hold as a result of the delay.
In a letter sent to Health and Human Services Secretary Sylvia Burwell announcing the results, WEDI said that unless all segments of the industry make a dedicated effort to move forward with implementation plans, significant disruption could take place October 1, 2015.
This call for unity is a necessity, as some still continue to oppose the transition using arguments that have been debunked repeatedly since the transition was announced. Ronald Franks, president of the Medical Association of the State of Alabama, wrote this week:
Ever been bitten by a killer whale? Have you sustained burns while waterskiing? Been hit by a spaceship? Know someone who was sucked into a jet engine more than once?
Though these sound bizarre, if a new and controversial medical coding system goes into place a year from now, those are exactly the kind of questions doctors across Alabama will soon have to ask patients in order to list a patient's diagnosis and treatment plan.
Of course, physicians won't "have to ask patients" these types of questions. ICD-9-CM already contains external cause codes like these, but ICD-10-CM expands on them. They're used for additional information, but generally are not a requirement for reporting diagnoses. Some payers may require them, especially if they currently require them in ICD-9-CM, but there's no national requirement to report them with ICD-10-CM.
But if physician groups continue to spread this type of ignorance instead of making sure their members' staff are fully prepared and trained to code in ICD-10, they will likely see a negative impact to their bottom line.
Staff that isn't trained to natively code in ICD-10-CM may rely on crosswalks to report diagnoses. Approximately two-thirds of providers plan to choose ICD-10 codes directly, according to the WEDI survey, which is slightly higher than the amount reported in an October 2013 survey. The number of providers who planned to only code using ICD-9 to ICD-10 crosswalks grew from about 13% in the 2013 survey to 25% in the latest survey. While many organizations are making progress toward coding in ICD-10, more plan to rely on crosswalks, especially among smaller providers, according to WEDI.
These crosswalks don't result in a one-to-one translation, though, so relying on them will result in reporting incomplete or unspecified codes.
A study found that hematology-oncology would be the least affected medical specialty by only using crosswalks, but a follow-up study published by the American Society of Clinical Oncology found that "information loss affecting 5% of billing costs could evaporate the operating margin of a practice."
The only way to guarantee this doesn't happen, and WEDI's prediction of significant disruption doesn't come true, is to come together, use the time granted by the delay wisely, and move the industry forward together.

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