Research Paper Help on Transition from Icd-9 to Icd-10 Codes and the impact on U.S. Healthcare

Transition from Icd-9 to Icd-10 Codes and the impact on U.S. Healthcare

Abstract

A regulation was passed that requires replacement of ICD-9 with ICD-10. These practices are facing a staggering number of technology requirements, including health information technology adoption, upgrading administrative transaction, e prescribing, and many others. Hospitals in the United States upgrade multiple information technology systems so that they can support the conversion from ICD-9 to ICD-10.

Introduction

In this chapter, implementing a variety of strategies is imperative. Regulatory compliance helps to achieve the highest possible levels of operational efficiency and effectiveness. “ICD-10” is an abbreviated term that refers to International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM). It is a code set and updated version of ICD-9-CM Volume 1 and 2. Previously, in the United States, ICD-9 was the set code used to report diagnosis and inpatient procedure. The healthcare industry undergoes a transition from ICD-9 to ICD-10 codes. The requirement of significant medical coder technical training for ICD-10-CM/PCS in an organization should assess the current and anticipated reporting needs or requirement of external stakeholders. The regulations of federal require all entities covered by the health insurance accountability and portability. For instance, the acts (HIPAA) to use ICD-10-CM/PCS codes are set for dates of service or discharge for inpatients that occur on or after October 1st, 2014. The diagnosis of ICD-10-CM code sets must be used in all healthcare settings, whereas the ICD-10-pcs procedure code is mainly set to be used solely by hospitals for reporting hospital inpatient procedures (Optum Insight, 2012).

Rationale

However, focus on healthcare data integrity that lead to the adoption of ICD-10-CM/PCS will allow the healthcare industry to reflect better, to have consistent data, and report comparability. It is important to note that ICD-9-CM will no longer be maintained after ICD-10-CM/PCS is implemented.

Literature review

Potential implementation cost and impact

Potential benefits of icd-10 implementation are very substantial. To achieve them, healthcare providers require making hard choices around capital investment and operating budgets. For example, the estimate of the Rand Institute implementation will cost healthcare providers between $425 million and $1.15 billion in total. Additionally, there will be $5 to $40 million a year in lost productivity. The impact of ICD-10 to healthcare providers will include multiple system upgrade and testing cycles, increased the needs for human capital, significant training, delayed payment, reduced reimbursement and impacts on cash flow, and more complex during financial reporting.

In the United State, hospitals are likely to upgrade multiple information technology systems so that to support the conversion from ICD-9 to ICD-10. Since ICD-10 is a complex code structure, implementing associated changes in electronic health records, billing systems, reporting packages and analytical systems will require either major upgrades of multiple system or replacement of the older system. According to Grider & American Medical Association (2010), the transition will necessitate capital cost that increase and outlays staffing to map and load codes, develop new reports, map dual coding systems, revise system interface, and eventually retain the users. The changes in the system will affect nurses, patient, physicians, financial services and finance, management case, administrators and other staff.

The adoption of ICD-10 requires significant technology changes for providers’ IT vendors, trading partners, external reporting entities and third-party payers. All external organizations or systems are reporting or accepting diagnostic, and procedure codes will require ability and modification to run dual-processing solutions. Cross work analysis, significant testing and data aggregation over time will be essential to prepare for the ICD-10 transition. The diagnosis of ICD-10-CM code sets must be used in all healthcare settings, whereas the ICD-10-pcs procedure code is mainly set to be used solely by hospitals for reporting hospital inpatient procedures as stated by (Grider & American Medical Association 2010).

Productivity loss in healthcare centers is anticipated in the functional areas that use ICD-9 codes on a routine basis. However, there are increased number of claims denials due to poor understanding of new codes set and coding requirements. Therefore, providers must prepare for this productivity reduction in order to prevent negative impacts to cash flow and reimbursement. Medical staff, coders, nurses, and allied health providers should enroll in training programs on revised and new clinical documentation requirements and coding nomenclature. Training needs anatomy and physiology courses, detailed clinical documentation requirements, coding practice experience with real-time feedback, and general awareness sessions for staff that currently use ICD-9 data. Practices that are carried out by physicians face financial and operational burden from ICD 10 implementations and other technological requirements. Typically, most physicians do no employ coders and thus are responsible for ICD-10 code assignment that potentially increases the risk of coding errors. The movement from ICD-9 to ICD-10 procedure codes and diagnosis raised privacy risks and protected health information security. Furthermore, it support health reform measures and becomes essential to accurate research information, billing and outcomes analysis.  

Conversion of ICD-9 to ICD-10

Many people believe that ICD-9 codes sets have become too outdated and are no longer workable for reporting, treatment, and payment process today. Since the year 1978,  ICD-9 has been used widely in the U.S. The WHO organization endorsed ICD-10 in the year 1990 and since then many countries have adopted the versions of it. Bowie, (2013)demonstrated how diagnoses of ICD-9 codes are dived into chapters based on body systems. Due to lack of codes within the proper chapter, new codes are assigned to chapters of other body systems. For instance, new cardiac disease codes may be assigned to the chapter for disease of the eye. Codes rearrangement makes finding the code that is correct and more complicated.

Additionally, ICD-9 is replaced since there is an increase in the specificity of ICD-10. It is believed that, the most specific data can provide better data for a particular diagnosis trends, epidemic outbreaks, public health need, and bioterrorism events. Therefore, codes that are precise are majorly supported by some potential benefits through claims that are fewer rejected.

Methodology

Preparation forICD-10 requires the following:

  1. Identification of the current system and work process, either manual or electronic, in which you use ICD-9. When it comes to implementation of the ICD-10 in an organization, will affect more than the transactions of the administrative. This process entails the following:
  2. Consult the current practice management system vendor
  3. Consult clearinghouses or billing service, if payers were used.
  4. Consult payers about the possible changes in the contracts as a result of implementing ICD-10.
  5. Identify potential changes to existing business process and work flow practice.
  6. Identify the needs for staff training
  7. Carry out test with trading partners
  8. The budget for implementation costs, including expenses for system changes, practice business process changes, training, and resource materials.

Discussion

In the healthcare system, there are structural differences between ICD-9 and ICD-10 that will make converting to the updated code that is set complex. The length of ICD-9-CM diagnosis codes is 3-5 digits in length. The letters E and V are the only alpha used in ICD-9-CM. In ICD-10-CM, the alpha codes are 3-7 numeric characters in length. The expanded characters of ICD-10-CM codes are known to provide greater specificity so that to identify the disease etiology, severity, anatomic site, and severity. Initially, the additional characters in the ICD-10-CM codes allow for identification of the body system, body part, root operation, and device involved in the procedure. In addition, there are also a greater number of ICD-10 codes as compared to ICD-9 system. The expansion of ICD-9 number diagnosis codes is from 14000 to 68000 in ICD-10-CM. The procedure codes of ICD-9 increases from 4000 to 87000 in ICD-10-CM (Bowie, 2013).

Therefore, the change in the length of the character requires system upgrades so that to expand data fields for longer codes. The HIPAA upgrade version 5010 transactions must be completed before implementing the ICD-10 set codes. The date that was set for implementing the 5010 transactions is on January 1, 2012. 

Recommendation

HIPAA recommends ICD-10-CM/PCS code to covers entities that comply with their regulation by using the codes in accordance with regulatory standards. Non-covered HIPAA entities implement ICD-10-CM/PCS in the same way as it covers entities. Specific data can provide better data for a particular diagnosis trends, epidemic outbreaks, public health need, and bioterrorism events. Therefore, precise codes will be supported by some potential benefits through claims that are fewer rejected.

Conclusion

In conclusion, a regulation was passed that requires replacement of ICD-9 with ICD-10. These practices are facing a staggering number of technology requirements, including health information technology adoption, upgrading administrative transaction, e prescribing and many others. Therefore, replacements of ICD-9 with ICD-10 act as a significant change for the healthcare community. The adoption of ICD-10-CM/PCS does not required for entities particularly which are not covered by HIPAA, such as casualty insurance health plans and property, disability insurance programs, workers compensation programs, state of agencies, and health data repositories such as registries (Falen & Liberman, 2007).

References

Bowie, M. J. (2013). Understanding ICD-10-CM and ICD-10-PCS: A worktext. Albany, N.Y: Delmar.

Falen, T. J., & Liberman, A. (2007). Learning to code with ICD-9-CM for health information management and health services administration. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Grider, D. J., & American Medical Association. (2010). Preparing for ICD-10-CM: Make the transition manageable. Chicago, Ill.: American Medical Association.

Optum Insight (Firm). (2012). ICD-10-CM and PCS coding readiness assessment: Measure coding skills and focus your preparation efforts for ICD-10.