Debbi Meisner, vice president of regulatory compliance for Emdeon, discusses three challenges every hospital should be discussing in preparation for ICD-10.
1. System upgrades. According to Ms. Meisner, system upgrades will be a major cost for many hospitals preparing to transition to ICD-10. This means hospitals should currently be evaluating their current system and speaking with the vendors about the ICD-10 transition. "This is a task they should have already been working on, and if they haven't, they need to get their heads down," Ms. Meisner says. "Everything that the ICD-9 program touches is going to have to be touched in this project."
She says the cost will vary depending on which vendor the hospital uses, how many vendors the hospital has and the ability to coordinate different vendors to support ICD-10 sets. Vendor preparation will also differ: "There are some [vendors] that are out there working on it, and there are some that still have their head in the sand and haven't been focusing on it," she says, mentioning that the transition to HIPAA 5010 competes as a priority for vendors and hospitals.
She says software will have to change significantly to accommodate ICD-10 codes, which are substantially different from ICD-9 codes. For example, the code has changed from a five-byte to a seven-byte code, meaning the size of the field that captures the code information will have to be increased. Additionally, the ICD-10 codes are made up of numbers and letters, while the majority of ICD-9 codes were made up of only numbers.
2. Physician documentation. The transition to ICD-10 will require training for various roles in the hospital, including coders, billing staff and physicians. Physician training is important because the requirements for documentation will change under ICD-10, as new diagnosis and procedural specificities come into play. "ICD-10 has added laterality, meaning left versus right," Ms. Meisner says. "They may have coded [that the physician] set a broken leg in ICD-9, but now it'll have to be left or right to [indicate] the specific leg."
She says if the physician fails to put that information into the medical transcript, the coder will not be able to code the procedure properly. "The physicians have to be better about putting details into the medical record," she says. To prepare for these changes, physicians will have to undergo documentation training prior to go-live.
3. Payor readiness. Ms. Meisner says there is some concern about the ICD-10 readiness of small payors who lack the funding to prepare as well as their larger counterparts. "This is [also a concern] for non-covered entities, such as the workers' comp industry and auto accident and other kinds of casualty businesses," she says. "There is concern that those pieces of the industry will not be ready for ICD-10, and that will be problematic for providers."
Payors that don't transition to ICD-10 by the go-live date of Oct. 1, 2013, will necessitate systems that can submit ICD-9 codes and ICD-10 codes after go-live, Ms. Meisner says. This also applies to re-submitted claims, which may be using ICD-9 codes for two years after the ICD-10 transition. "Unlike the other HIPAA transaction-based regulations that were based on the date of submission, ICD-10 is following the same pattern as other code set updates and is based on the date of service," she says.
Learn more about Emdeon.
Read more about ICD-10:
-10 Steps to Prepare for ICD-10
-Hospitals Shouldn't Expect Vendors to Comply With Healthcare IT Regulations
-CMS to Enact Partial Code Freeze Before ICD-10 Implementation
1. System upgrades. According to Ms. Meisner, system upgrades will be a major cost for many hospitals preparing to transition to ICD-10. This means hospitals should currently be evaluating their current system and speaking with the vendors about the ICD-10 transition. "This is a task they should have already been working on, and if they haven't, they need to get their heads down," Ms. Meisner says. "Everything that the ICD-9 program touches is going to have to be touched in this project."
She says the cost will vary depending on which vendor the hospital uses, how many vendors the hospital has and the ability to coordinate different vendors to support ICD-10 sets. Vendor preparation will also differ: "There are some [vendors] that are out there working on it, and there are some that still have their head in the sand and haven't been focusing on it," she says, mentioning that the transition to HIPAA 5010 competes as a priority for vendors and hospitals.
She says software will have to change significantly to accommodate ICD-10 codes, which are substantially different from ICD-9 codes. For example, the code has changed from a five-byte to a seven-byte code, meaning the size of the field that captures the code information will have to be increased. Additionally, the ICD-10 codes are made up of numbers and letters, while the majority of ICD-9 codes were made up of only numbers.
2. Physician documentation. The transition to ICD-10 will require training for various roles in the hospital, including coders, billing staff and physicians. Physician training is important because the requirements for documentation will change under ICD-10, as new diagnosis and procedural specificities come into play. "ICD-10 has added laterality, meaning left versus right," Ms. Meisner says. "They may have coded [that the physician] set a broken leg in ICD-9, but now it'll have to be left or right to [indicate] the specific leg."
She says if the physician fails to put that information into the medical transcript, the coder will not be able to code the procedure properly. "The physicians have to be better about putting details into the medical record," she says. To prepare for these changes, physicians will have to undergo documentation training prior to go-live.
3. Payor readiness. Ms. Meisner says there is some concern about the ICD-10 readiness of small payors who lack the funding to prepare as well as their larger counterparts. "This is [also a concern] for non-covered entities, such as the workers' comp industry and auto accident and other kinds of casualty businesses," she says. "There is concern that those pieces of the industry will not be ready for ICD-10, and that will be problematic for providers."
Payors that don't transition to ICD-10 by the go-live date of Oct. 1, 2013, will necessitate systems that can submit ICD-9 codes and ICD-10 codes after go-live, Ms. Meisner says. This also applies to re-submitted claims, which may be using ICD-9 codes for two years after the ICD-10 transition. "Unlike the other HIPAA transaction-based regulations that were based on the date of submission, ICD-10 is following the same pattern as other code set updates and is based on the date of service," she says.
Learn more about Emdeon.
Read more about ICD-10:
-10 Steps to Prepare for ICD-10
-Hospitals Shouldn't Expect Vendors to Comply With Healthcare IT Regulations
-CMS to Enact Partial Code Freeze Before ICD-10 Implementation