Ready or not, the U.S. healthcare industry is poised to flip the switch from the ICD-9 to the ICD-10 diagnostic and procedural coding system on Oct. 1, significantly changing how billions of dollars in medical claims are calculated and billed every day.
Experts predict most large hospitals and health systems and most large physician groups will weather the federally required conversion just fine, though they could experience temporary cash-flow squeezes because of ICD-10-related payment delays.
The organizations most likely to have trouble, however, are smaller providers, particularly smaller physician practices. Some medical groups say problems associated with the conversion could drive some small doctor groups out of business.
A last-minute reprieve is unlikely. After three previous delays of the ICD-10 start date, no one predicts there will be a fourth.
At Advocate Lutheran General Hospital in Park Ridge, Ill., coders have been training for the changeover since January, which has made it hard for them to do their regular work. “We're as prepared as we're going to be,” said coder Kathy Scuderi. Everyone just wants to switch to ICD-10 and “get this over with,” added coding supervisor Sandria Robinson.
For the Advocate system as a whole, Dr. Anupam Goel, vice president of clinical innovation, voiced confidence that Advocate's 11 hospitals, 1,500 employed physicians and 3,000 affiliated physicians are ready. The one-year extension Congress granted last year was needed, he said.
The ICD-10 code changes will affect all Health Insurance Portability and Accountability Act-covered entities—hundreds of thousands of providers, payers and claims handlers. The codes will be used to authorize and calculate trillions of dollars in payments from Medicare, Medicaid, commercial insurers, Tricare and the Veterans Health Administration to hospitals, physicians and other providers. ICD-10 is a much more complex and detailed coding system than ICD-9, which has been used since the 1970s. For providers, there are about 68,000 diagnostic codes under the new ICD-10-CM (clinical modification) codes—five times more than under ICD-9-CM.
There is an even more complex matrix of 87,000 new codes for hospital-based procedures in the ICD-10-PCS (procedural coding system)—29 times more codes than in ICD-9.