Many of the issues we encounter today with the ICD-9 diagnosis and procedure code sets are resolved in ICD-10. Listed in the table below are some of the differences we will encounter between the two code sets:
ICD-9 ICD10
Approximately 13,000 codes Approximately 68,000 available codes
3-5 Characters in Length 3-7 Characters in Length
First digit may be alpha or numeric Digit 1 is alpha, 2&3 are numeric, 4-7 are alpha or numeric
Limited space for adding new codes Flexible for adding new codes
Lacks detail Very Specific
Lacks laterality Has laterality (i.e. codes designating left vs. right)
The American Asspcoation of Orthopaedic Surgeons, along with 11 other healthcare organizations, released a study conducted by Nachimson Advisors, LLC, which suggests that HHS has underestimated the cost of implementing the ICD-10 code set. According to the study results, the implementation cost for a three-physician practice could be as much as $83,290, while a 100-physician practice might pay more than $2.7 million.
The impact of this shift is substantial. Not only does the new code set include five times as many codes as the ICD-9 code set, the different arrangement of codes will require more documentation, revised forms, retraining of staff and physicians, and changes to software and other information technology. Changes in reimbursement patterns may also result from the increased specificity of the new code set.
Implementing these two requirements—the next generation HIPAA transaction standards (5010) and the ICD-10 code sets—will result in many potential costs to physicians. Among these costs are staff education and training, changes in health plan contracts, coverage determinations, increased documentation, changes to superbills, information technology system changes, and possible cash flow disruption.
In addition to billing software modifications necessitated by this momumental change, analyzing the impact of ICD-10 on a practice’s business processes will also be costly. As health plans modify their contracts to include the more specific codes, they may also alter their payment schedules, resulting in changes to a practice’s cash flow.
Analyzing the impact of ICD-10 on a practice’s business processes will also be costly. As health plans modify their contracts to include the more specific codes, they may also alter their payment schedules, resulting in changes to a practice’s cash flow.
According to the study, the move to the ICD-10-CM will increase documentation activities about 15 percent to 20 percent.
This translates into a permanent increase of 3 percent to 4 percent of physician time spent on documentation for ICD-10-CM. As the study notes: “This is a permanent increase, not just an implementation or learning curve increase. It is a physician workload increase with no expected increase in payment, due to the increased requirements for providing specific information for coding. Electronic health record systems will not be able to eliminate the extra time requirement.”
In light of the unavoidable added cost to the practice due to mandated implementation of ICD-10 coding, every physician should conduct a detailed analysis of his business costs. Outsourcing the most time consuming and labor intensive administrative aspect of the practice - medical claims and accounts receivable management - could very possibly offset the income lost as a result of professional time spent on increased medical record documentation.
