ICD-10 Delay: What's Next For Healthcare Organizations?
Healthcare organizations have at least four options for dealing with the delayed implementation of new diagnostic codes.
Easy-to-Mock ICD-10 Diagnosis Codes
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Many of the complexities of medicine are distilled down to a vocabulary of diagnostic codes, called the International Classification of Diseases (ICD), which are used by doctors, insurers, and hospitals. Today's ICD-9 codes are now more than four decades old. Although the US was aiming to transition to ICD-10 by Oct. 2014, the recently announced postponement, until at least October 2015, presents a dilemma for many providers that were ready to activate the new system. The question that remains is how best to move forward?
It's not hard to imagine how the added specificity will drive advancements in managing patient populations, as providers and payers transition from roughly 14,000 codes in ICD-9 to around 69,000 in ICD-10. The lack of detail in ICD-9 has often compromised the accuracy of coding, with the conveyed information subject to differing interpretations. For example, the trimester of a pregnancy is clinically relevant to many patients' cases, but ICD-9's coding is not specific enough to convey this information.
The change has been a long time in coming, but readiness levels vary. It isn't just a question of coding work -- organizations' workflows and processes must also be re-engineered. A database using the language of ICD-10, say, will not work properly with models that still speak ICD-9.
Think of a classic bell curve: While many organizations are at the middle or advanced end of the curve, there are also those that are behind.
Many of the organizations working on ICD-10 have been simultaneously implementing electronic medical record (EMR) systems that take into account the new codes. While ICD-10 wasn't developed for payment systems, these EMRs lead to reimbursement and revenue cycle systems. The two go together; unless both function effectively, providers risk not getting paid.
Organizations ready for ICD-10 may see this delay as an inconvenience, though, a pragmatic compromise if it nudges the full industry closer to compliance. Providers still completing remediation and testing may intend to stick with their timelines, but will now know there is room for slippage. Any that are significantly behind will definitely see the delay as giving them an extra year to readjust priorities.
All organizations will want to use the delay to trigger a review of their readiness, and the results will in large part determine their response. The extra time also gives a bigger window for remediation and testing, including external testing, as well as giving providers longer to comply with the meaningful use directive (and package vendors to obtain meaningful use certification).
On the other hand, the delay will increase the cost of the ICD-10 program and may cause difficulties with resource allocation, particularly since this is
Kaveh Safavi, M.D., J.D., is the global managing director for Accenture's health business. He oversees the payer, provider, and public health offerings and is responsible for the health strategy, growth initiatives, and market capabilities. Safavi joined Accenture from Cisco ... View Full Bio