By Laura B. Powers, MD, FAAN, and William S. Henderson, FACMPE
|Laura B. Powers, MD, FAAN||William S. Henderson, FACMPE|
On January 16, 2009, the Center for Medicare and Medicaid Services (CMS) published a Final Rule announcing that ICD-10-CM (diagnosis coding) and ICD-10-PCS (procedure coding for hospital use only) will be implemented for all users on October 1, 2013. This rule was reconfirmed by the Obama administration. The implementation date was pushed back from the originally proposed 2011 date as a result of requests by many organizations, including the AAN.
ICD-9-CM, which is in current use, is 30 years old and both out-of-date and inflexible. Though greater than 10 years old itself, ICD-10-CM affords more modern terminology but is also a much larger system, containing 68,000-plus codes as opposed to 14,000-plus codes in ICD-9-CM. One potential benefit of having more "granular" diagnosis reporting will be fewer requests for supplementary documentation. This granularity will be necessary to measure the level of quality and medical necessity the public is demanding for its dollars, and is meant to reduce fraud and abuse. An earlier article on AAN.com discusses other details of the new system. The Academy is planning educational offerings on ICD-10-CM closer to the implementation date.
Publishers are beginning to produce print versions of ICD-10-CM. Members can download free versions of the index and tabular volumes, as well as the guidelines and a crosswalk between ICD-9-CM codes and ICD-10-CM codes, called "General Equivalence Mapping" ("GEMS"). CMS held several teleconferences last year about getting ready for ICD-10-CM, and its initial educational tool is available online. Be advised that there will be a few more changes to ICD-10-CM before the implementation date.
So what should members do now? It is probably too early to spend time learning the new system in detail. On the other hand, it is time to begin looking at office systems and planning budgets for future expenses related to the transition. If your practice management system (PMS) is more than seven years old, you may find it necessary to purchase a new PMS. While many vendors will try to support their legacy PMS products, the costs for upgrading to ICD-10-CM might be expensive. You should contact your PMS vendor and find out if it is committed to upgrading your PMS to accept ICD-10-CM. Make sure to get the commitment in writing. If the vendor is in fact engaged in preparations, you need to find out estimated costs for the upgrade. Several PMS vendors have already committed R&D resources to implement these changes, even though the rollout date is four years away.
Often overlooked is that all PMSs must also adopt the new ASC 5010 standards by January 1, 2012. This involves updated codes and transactions standards under HIPAA that will cover improvements to electronic claims, insurance eligibility verification, claim status inquiries, requests for authorizations, and electronic remittance data. While legacy PMS users could find a clearinghouse to process data on their behalf, the benefits of these changes are that the newer PMS products can transmit and retrieve much more relevant data on patients than ever before.
The Medical Group Management Association suggests that the potential cost to upgrade an existing PMS to accommodate ICD-10-CM could exceed $7,500 for a small practice (1 to 2 MDs), while the change to ASC 5010 could add another $10,000 (plus monthly processing fees through a clearinghouse).
Because it is certain that these changes will require additional codes—but will also clearly provide significant benefits—it may be time for physicians to begin researching replacement options for their older PMS. And they have an incentive to do that: In light of the federal HITECH Act which commits $17.2 billion dollars to physicians to "meaningfully use" an EHR, now is the time to begin to seriously research integrated PMS/EHR products that will include the ICD-10-CM and ASC 5010 changes—and benefits.
Within the past 24 months, Dr. Powers served as an expert witness or consultant in three separate court cases.
Mr. Henderson has nothing to disclose.