Janice Jacobs minces no words about the impact of ICD-10, the forthcoming update to the nation's procedure and diagnosis classification and coding system. And while much has been written about the transition, and some organizations are up to their elbows in planning, it never hurts to be reminded of the impact.

"It's a change of such momentous proportion," says Jacobs, director of IMA Consulting. "It is unlike anything that has happened to the industry." Even the introduction of diagnosis-related groups, the foundation of prospective payment, pales in comparison, she adds. "DRGs did not affect every single department like I-10. This is a change that will affect every single functional area in the hospital, every person and system that touches a claim. We don't really know what will happen in 2014. I do envision a lot of claim rejections."

The consultant is not alone in her anxiety. The industry for the most part is still in the ICD-10 planning stages, but as it gets deeper into the task, and hears from organizations that have made some headway with ICD-10, the grim reality of transitioning to ICD-10 is starting to settle in. And all too many stakeholders are having to scramble to craft transition strategies, set up executive-driven governance structures and complete internal systems impact assessments.

The I.T. side of the house also is starting to get a better idea of just how much work they'll have to put in. The transition will require remediation of any system housing ICD-9 codes-which, it's increasingly obvious, means just about anything in the clinical documentation and revenue cycle arenas. But systems remediation is not the sole job that needs to be done. Providers are also analyzing any likely revenue hit under ICD-10-which will require vastly more detailed documentation than physicians currently provide in order to submit a clean claim. Witness the sudden emergence of "CDI" initiatives, short for clinical documentation improvement. And they also are looking at likely areas of lost productivity, particularly among coders-a group which will have to learn the equivalent of a foreign language, one interlaced with concepts not present in their native tongue. Productivity concerns are a prime reason why many providers are adopting computer-assisted coding software (see related story).

The wild card is the actual ICD-10 compliance date. CMS has postponed its implementation several times, even after asserting that the most recent ostensible go-live date of October 2013 was etched in stone. The American Medical Association also seems to be trying to keep that deadline on the far horizon, even suggesting that the industry skip to ICD-11, which is not yet ready for prime time.

The delays leave the United States in the dubious position of being one of the last remaining industrialized nations not yet on the coding system, which was crafted by the World Health Organization. Canada, for example, implemented ICD-10 nearly a decade ago. "The move to ICD-10 is long overdue," says Jacobs, echoing a near-unanimous sentiment among data quality experts. "We can't afford to keep delaying. There have been so many advances in medical technology that can't be categorized in ICD-9."

Gary Baldwin’s feature story in the September issue of Health Data Management, “ICD-10: Time to Get Serious,” examines the work being done and challenges being tackled by stakeholders, and tools available to help.

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