The International Classification of Diseases, ninth revision (ICD-9) has been in use for more than 35 years in the United States. But now the transition to ICD-10 medical coding is mandatory from October 1. The new codes are much more helpful in tracking public health condition, ensuring quality of care and also preventing healthcare fraud and abuse. This massive overhaul of the national coding system will be the most significant change to the U.S healthcare sector in decades.
ICD-10 accommodates 69,000 codes whereas ICD-9 has only 14,000. The transition to ICD-10 is compulsory for healthcare providers though they face many challenges in its actual implementation. However, the change is worthwhile as it has the following benefits:
- The new set of codes will help healthcare providers to share health and disease data among most of the developed countries around the world effectively. It assures better alignment with the international standards.
- ICD-10 codes are developed to assist with physician reimbursement. They use standardized and improved definition that helps to provide accurate details about the patient’s condition, thereby preventing possible claim delays and denials and ensuring timely payments for services.
- Since more detailed information can be provided about the patient’s current health condition and medical history, ICD-10 codes ensure accurate and consistent treatment and also improved quality of care.
In spite of the advantages in implementing ICD-10, there are some challenges involved. Here are some major considerations:
- ICD-10 is much more advanced than ICD-9 and so it requires more technological upgradation and system replacement in electronic health record, revenue cycle management and in other business and analytical systems.
- With the implementation of ICD-10 there may be productivity loss initially. This is because it requires increased amount of time in management, medical billing and coding, case management and obtaining reimbursement. In Canada, implementation data shows that there was a loss of 50-70 percent in productivity initially which gradually reduced to 20 percent in the first 12 months.
- In the beginning stages of transition there may be delay or denial of claims or slower reimbursement due to wrong coding. With time, healthcare providers and others staffs will gain experience in using ICD-10 and other updated billing software that will reduce miscoded claims and facilitate quick reimbursement.
- The transition from ICD-9 to ICD-10 will require a new software vendor. The current software vendor may be unable to satisfy the needs of administrative and claim reimbursement services. A new software vendor can help in a smooth transition to ICD-10 codes.
- There may be reduced cash flow while implementing ICD-10. This is because capital investments are required for training the staff about the new coding system, upgrading software and so on. This may lead to reduced cash flow which can have an impact on healthy organizations, but they will pick up as time goes by.
Implementation of ICD-10 requires careful planning and preparation. Choosing a reliable medical billing and coding company can help to overcome many of these issues. Outsourcing ICD-10 coding to these service providers is advisable because they have already transitioned to ICD-10 and have become experts in using the new system. In addition, they have proficiency in coding. Partnering with a reliable healthcare business process outsourcing company is a practical option for providers looking for a quick and flawless implementation of ICD-10 and consistent revenue flow.