The countdown begins by Liz Carmack and Katie Ford
A
ny physician in business for more than a few months knows how difficult it is to work on the
business. Keeping pace with caring for patients, insurance company demands, government regulations, and the latest medical technology means there are never enough hours in a day. However, a looming federal deadline is prompting physicians nationwide to look at the big- ger picture. Unless organized medicine can stop
it, on Oct. 1, 2013, medical practices, health insurers, and clearinghouses must begin using International Statisti- cal Classification of Diseases and Relat- ed Health Problems (ICD)-10 to record all diagnoses and inpatient procedures. Mandated by the U.S. Department of Health and Human Services, the up- grade from ICD-9 will enable doctors’ offices to collect and exchange more- detailed patient data. According to the American Academy of Professional Cod- ers (AAPC), only a handful of countries
— including the United States and Italy — have yet to adopt ICD-10 as their stan- dard for reporting. Spurred by its Texas members, the
American Medical Association House of Delegates voted at its interim meeting in November to oppose the switch to ICD- 10. Delegates adopted a Texas Medical Association resolution that asks AMA to “immediately petition the Centers for Medicare & Medicaid Services to stop implementation and development of all new coding and billing standards includ- ing ICD-10.” AMA delegates voted to direct AMA to “vigorously work to stop the imple-
mentation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine” and to “work with other national and state medical and informatics associations to assess an appropriate replacement for ICD-9.” “ICD-10 is going to be an absolute di-
saster in implementation for the physi- cians of this country,” TMA Trustee Da- vid Teuscher, MD, of Beaumont, told the AMA Reference Committee on Legisla- tion in urging the committee to support the resolution. “It will be disastrous for those who are our members, and they will ask, ‘Why didn’t the AMA do some- thing?’ Those who are not our members will say, ‘See, the AMA didn’t do some- thing.’ It is time for the AMA to stand up and say ‘no’ to the implementation of ICD-10.” He said estimated ICD-10 implemen-
tation costs for a three-physician prac- tice are $83,000 per doctor and $28,500 per physician for a 10-doctor practice. AAPC characterizes the transition
to ICD-10-CM (clinical modification) for diagnostic code reporting and the implementation of ICD-10-PCS (proce- dural coding system) for inpatient proce- dural reporting as the most challenging initiative since the inception of medical coding. The number of diagnostic codes under ICD-10-CM will grow from 13,500 to 69,000. The number of codes for in- patient procedures under ICD-10-PCS will soar from 4,000 to 71,000. “There’s more to ICD-10 than just learning a new code set and upgrading your software,” said Stephen Spain, MD, a Tyler family practice physician who sits on AAPC’s National Advisory Board.
“The transition will affect every aspect of your practice.” Anticipating the transition, stakehold-
ers in the health care industry are work- ing toward widening the electronic high- way by upgrading the medical data ex- change platform, Health Insurance Por- tability and Accountability Act (HIPAA), from Version 4010 to 5010. Completed Jan. 1, the HIPAA upgrade allows the industry to adopt ICD-10’s new alpha- numeric coding, which uses seven char- acter spaces instead of five. “One of the very first changes was ev-
erybody getting on board [with v5010] so we can communicate,” Dr. Spain said. “It’s as if we’ve been using a VW Beetle and now we need an eight-passenger van.” Though the v5010 conversion threw
a learning curve at physicians and pay- ers, it includes “fixes” for nearly all the implementation workarounds that sprang up under the nearly decade-old 4010 transaction standards. Some of the improvements include more functional- ity and relevant data behind authoriza- tion and referral transactions, enhanced present on admission (POA) reporting on claims, and greater detail behind eligibility transactions, which should reduce follow-up calls between medical practices and payers to clarify coverage.
Anticipated benefits and impact According to Dr. Spain, ICD-10 cod- ing will allow physicians to document patient data in much richer detail. For instance, if a patient has a broken arm, there are specific codes to identify lat- erality, whether the break occurred in
February 2012 TEXAS MEDICINE 25
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