Is the ICD-10 transition a rehab project or teardown? At this point it's up to debate, says David Biel, a principal in the ICD-10 practice at Deloitte LLP in Chicago.

Many payers, providers and state agencies--too many, Biel notes--are still in the assessment phase of the ICD-10 transition. While some are focusing on implementing crosswalks and using the CMS general equivalency maps, others, realizing the enormity of the transition from ICD-9 to ICD-10, are considering complete system replacements. "The question being mulled by a lot of organizations is if they want to deal with all the complexity of crosswalks and trying to 'wrap and map" their coding data, or do they want to implement completely new coding technology."

Biel adds that before the reform law hit the streets in March, there was "good movement" around preparing for the ICD-10 transition. Since then, however, organizations have been distracted and progress has slowed. Informal surveys by Deloitte find that about 50 percent of payers have done ICD-10 assessments, when at this juncture insurers with 3 million or more members should be in a validation phase, he says. "While payers are way ahead of providers and state agencies, they're not where they need to be," he says.

Biel adds that everyone should plan for decreases in coding efficiency when ICD-10 goes into effect in 2013, and those efficiency decreases could last for years, party exacerbated by the shortage of coders. "This is open heart surgery."

--Greg Gillespie


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