On October 1, 2013, medical coding in United States health care settings will change from the current system, International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), to the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). The new, federally mandated version expands the number of codes from 24,000 to 155,000, making it more precise and descriptive and more accurately describing the diagnoses and inpatient procedures of care delivered.

The transition will require significant business and systems changes throughout the health care industry and will impact all processes and people from finance to compliance to doctors.

Every organization that is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition including:

• Hospitals
• Physicians
• Freestanding Outpatient Facilities
• Home Health Agencies
• Ambulatory Surgery Centers
• Reference Laboratories
• Long-Term Care Facilities
• Insurance Companies

ICD-10 codes must be used on all HIPAA transactions, including outpatient and inpatient claims with dates of service or discharge dates on and after October 1, 2013. Failure to convert by the federally mandated date will result in immediate rejection of all transactions so it is imperative that providers start now to prepare for the changeover to ICD-10-CM.

Experience has shown that even a well-choreographed transition will ultimately impact cash flow and productivity of the hospital staff. For this reason, HRAA will provide staff when needed to support the internal team and ensure minimal impact to the bottom line. While coding plays the central role in this transition, documentation and accuracy, along with auditing and analysis, have strong supporting roles.

Impact of New Regulation

• This new system will require time, money and commitment by over 6,000 hospitals, 200,000 physicians and every payor in the United States.
• As of October 1, 2013, all claims submitted by hospitals and physicians for reimbursement without utilizing ICD-10 will result in immediate rejection and non-payment.
• Initial estimates based on other countries that have converted predict a 50% loss of productivity due to the complexity of the new system, stemming from allocating more time preparing each individual case.
• Re-education/training of every HIM department is required.
• Every discipline in the hospital will be affected as they all revolve around the same coding system.
• Massive backlogs are imminent. Backlog in coding means greater time between payments and crippling financial deficits.

CLICK HERE FOR HRAA’S PATH TO ENLIGHTENMENT – A JOURNEY THROUGH THE ICD-10 TRANSITION.