Healthcare // Policy & Regulation
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5/7/2014
09:06 AM
Deborah Graham
Deborah Graham
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ICD-10 Momentum: Let It Roll

IT teams can accomplish great things when they must meet or beat a deadline, like Y2K. The ICD-10 transition has been delayed, but CMS can still act to keep momentum building.

for the worst. Programmers were in high demand, especially those COBOL programmers who were not otherwise needed much anymore. Someone had to read the old code and make sure wherever a date was referenced or used, it could tell the difference between 1900 and 2000. Given a hard and fast deadline, companies did what they needed to do to stay open and in business.

I was working at a company with 24/7 customer support at the time, and we representatives worked 12-hour shifts: 8 a.m. to 8 p.m. or 8 p.m. to 8 a.m. I opted for the 8 p.m. to 8 a.m. shift, as I wanted to be at work if the world came to an end. No one else wanted the overnight shifts, so I figured I'd get a lot of work done with fewer people around at 3 a.m. to hold meetings or chit-chat. Those of us who were working on December 31, 1999, went to a conference room at midnight and watched the ball drop. The TV was still working -- that was a good sign; it didn't think it was 1900, before it had been invented. Outside, the lights were still on and traffic was flowing, so cars hadn't stopped in their tracks.

Then our "Y2K issues" phone rang. We all held our breath. It turned out that one customer had found one report where the date was printing as 1/1/00. Within about 15 minutes the rep had changed the format of the report so that it printed correctly. Major crisis averted! You could hear the collective sigh of relief. Because we faced a hard deadline, we all clearly understood what needed to be done and when it needed to be done -- and we did it.

The X12 version 4010 to 5010 transition was different. The ANSI ASC X12N 837 Health Care Claims version changed to accommodate the anticipated transition to ICD-10. There was also a change to allow 12 diagnosis codes (4010 allowed eight codes to be sent). There was a hard deadline by which everyone had to switch, but CMS and the commercial payers allowed providers to transition to the new format early if they tested and were approved.

This dual coding effort had a lower level of urgency than Y2K. There wasn't a feeling that we needed to gear up the workforce with lots of temporary workers who had limited skill sets. We could take current employees or consultants and bring them up to speed on the requirements for the new specifications. Then, working methodically and with one payer at a time, we tested and switched over in a controlled manner. There was no specific date when we finished -- it was complete when the last payer's claim forms converted over to the new format.

Contrast with ICD-10
I had hoped that, despite the law, the transition to ICD-10 could proceed on something like the X12 Version 4010 To 5010 model. But CMS recently announced it will not accept any ICD-10 coded claims until the deadline. I expect that many companies will stop all current cost-savings efforts and attempt to resume in a year or even later -- anticipating another delay or even total cancellation of the switch to ICD-10. I also predict that we'll see a lot less testing and remediation work happening until at least this time next year. At my company, we have stopped transition efforts and started to let the ICD-10 consultants go.

In my opinion, CMS is making a mistake. They should ask (since the law says they cannot insist) providers to send ICD-10 coded claims and turn the effort into a dual-coding process, allowing organizations to test with CMS and the commercial payers and switch over from ICD-9 to ICD-10 coded claims as each payer is ready. That way, organizations can continue their work in progress, finish the ICD-10 preparations they've already started, and get the job done, allowing the industry to move on to the next issue at hand.

Download Healthcare IT In The Obamacare Era, the InformationWeek Healthcare digital issue on changes driven by regulation. Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but ACOs also put new demands on IT.

Deborah Graham is a senior programmer/analyst at a large hospital system in Massachusetts working in the IT department on the provider practice side of the organization. She has more than 14 years of healthcare IT experience and over 25 years of programming experience in a ... View Full Bio

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Alison_Diana
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Alison_Diana,
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5/8/2014 | 10:30:28 AM
Dual Coding
Interestingly, when it appeared ICD-10's deadline was really set in stone, one suggestion I heard from several HIT professionals was the recommendation you make at the end of your column: Dual-coding. I brought up the idea to an ICD-10 CMS exec at HIMSS. She was adament that CMS would not do this -- but this was when CMS decried all thoughts of delaying ICD-10 again. Since so many organizations have worked to meet the Oct. 2014 deadline, dual-coding would reward them for diligence by granting them 12 months of live testing. CMS said it was ready to go; it's said that repeatedly. 
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