ICD-10 is the biggest change facing the health care industry since the introduction of Medicare, said Robert Tennant at the Medical Group Management Association annual conference in San Antonio.
Tennant, MGMA’s senior policy analyst, made the comparison based on the depth and breadth of the new coding system’s impact. Set to launch in October 2014, the new coding system “will impact every information system, process and transaction,” Tennant told attendees at the group’s annual convention. And like Medicare, ICD-10 will sport a hefty price tag. Tennant presented MGMA data suggesting that a three-physician group practice faces a conversion cost of $84,000, including system costs, training and lost productivity. For a larger group of 100 physicians, the cost would be $2.7 million; estimates that Tennant says are conservative.
For your consideration: Recent MGMA Comments on ICD-10
During the presentation, Tennant debunked various myths associated with the coding and classification system. For starters, he contested the idea that ICD-10 is widely used internationally. No other country has deployed the version of ICD-10 which is set to go live in the United States in 2014, and among countries that have adopted other versions, the outpatient setting is often excluded. Germany carved out an exception for primary care physician office visits for example.
Tennant acknowledged that the ICD-10 predecessor, ICD-9, falls fall short when it comes to describing diagnoses and procedures. The problem is that the industry doesn’t know how payers will apply the new coding system to their payment policies. Nor does the industry know when payers themselves will be ready--or if they will be ready in time for the deadline, extended for the second time earlier this year. “The single most tenuous issue is how payers will apply ICD-10 to payment policy,” he said. “No health plan, including CMS has released a payment schedule.”
Studies show a large portion of claims arrive at payers’ doorsteps with “unspecified” code assignments, meaning the provider did not describe with any detail the granularity of diagnosis--even in ICD-9, he noted. A similar claim in ICD-10 might be rejected.
“Most likely, many payers and clearinghouses won’t be ready,” Tennant said. “We will almost certainly have to have dual coding. That will create all kinds of issues for practices. We will see proprietary crosswalks across the industry.”
Tennant urged group practices to begin their systems inventories and reach out to vendors to explain their ICD-10 transition schedules. Some may plan to upgrade only certain versions of their products, compelling practices with older versions to install a new version.
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