ICD-10 Remains High Priority Despite Delay

Easy-to-Mock ICD-10 Diagnosis Codes

The transition to the ICD-10 standard for diagnosis and billing codes remains a big factor in the health IT jobs market, despite Congressional action delaying implementation of the program for at least a year.

The demand for technical, clinical, and project management skills needed for the conversion from ICD-9 to ICD-10 have been in high demand for the past year, and the legislative delay "hasn't seemed to decrease the need a whole lot," says Cherie Lester, senior healthcare IT recruiter with the Holland Square Group.

"ICD-10 is the driving factor right now -- even though those lovely people in Washington gave us another year, we haven't slowed down," says Deborah Graham, senior programmer/analyst at UMass Memorial Health Care.

[In the market for a new job? Read EHR Jobs Boom: 8 Hot Health IT Roles.]

Graham and others were interviewed for a coming report on the InformationWeek Healthcare IT Salary Survey, and many survey participants volunteered that their organizations are steaming ahead almost as if the deadline for implementation were still Oct. 1, 2014.

Earlier this month President Obama signed a delay in the mandate into law -- as one sentence in a broader bill averting a scheduled decrease in Medicare reimbursements. Decried by some as a triumph of politics over health data quality, the change arrived at an awkward time for health system project managers who had been working hard to get ready, with systems changes and training programs already in motion.

"The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for codes sets," reads the pertinent section of the bill.

Figure 1: Current LinkedIn job postings asking for ICD-10 skills.

A brief statement atop the CMS web page for the ICD-10 program says, "CMS is examining the implications of the ICD-10 provision and will provide guidance to providers and stakeholders soon." It's not 100% clear that the program will move forward with a new implementation date of Oct. 1, 2015. Although it's assumed to be the most likely outcome, CMS could take a radical action, such as punting until the arrival of the ICD-11 version of the standard currently under development. Aside from a few reassuring comments from a CMS official who spoke Wednesday at the ICD-10 Summit hosted by the American Health Information Management Association, the agency has left healthcare organizations guessing.

Graham hopes those organizations that have been marching toward an Oct. 1 deadline will be able to go forward with ICD-10. "They can't require it, but there's nothing in the law says they can't beg us for it." In other

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words, CMS could make submitting Medicare claims in ICD-10 optional and begin to make use of the greater detail it provides. "We would jump at that chance, in my group," says Graham.

Even before the bill passed Congress, healthcare leaders such as Cleveland Clinic CIO Martin Harris were wondering about the practicality of submitting claims in ICD-10 format to payers who are ready to accept that data. So far, it's not clear whether Medicare or any other payer would want to start accepting ICD-10 data for a fraction of new claims, which would mean supporting a mix of the two coding schemes. There will be some overlap, regardless, because unpaid claims submitted in ICD-9 format will be in circulation whenever ICD-10 goes into effect. However, it would be logistically simpler for CMS and other payers to keep the overlap to a minimum.

Regardless, healthcare IT workers interviewed were unanimous in saying it makes sense to begin collecting more detailed clinical documentation on the schedule they originally planned so they can begin generating ICD-10 codes whenever they are allowed or required. Those we spoke with worked in hospitals and health systems, rather than the smaller healthcare practices that most dreaded the transition.

"People are still lining things up, although maybe the heat and the fire is less intense," said Jaime Anand, an informatics outreach architect at UC Irvine Health. The extension of the timeline can be put to good use, she feels. "A year ago, you couldn't find enough testing people, but now there are a lot of testing people" to help prepare for the change. As with other big shifts in healthcare data management, such as the advent of medication reconciliation lists, the change, she says, "was never going to happen in a single day, overnight."

Another healthcare IT manager, who asked that his name not be used, said his firm's ICD-10 preparations are a matter of "being proactive and trying to prepare for the storm, as opposed to scrambling when it's mandated."

Alan Matsumura, a founding partner with consulting firm Sagence, said the transition to ICD-10 has been like the Y2K crisis for healthcare -- but one that won't take another thousand years to recur. "By this time, you have to be convinced that there's going to be an ICD-11," he told us. That means organizations ought to be focused on adopting "systems that are more amenable to changes over time."

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