Considerations for ICD 10 Conversion
The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD 10) is a coding mechanism for diseases and other health conditions. The medical code set includes more than 14,400 different codes and allows for more tracking capability than the previous code set (ICD 9). The United States will begin official use of ICD 10 on October 1, 2013. Although other countries have been using ICD 10 for some time, the US has delayed it due to push-back from healthcare providers who see this conversion as a big challenge. All HIPAA covered entities must make the change to the updated medical code sets.
At this point, it's no longer a matter of if or when but how to approach ICD 10 conversion. Most healthcare provider organizations are resigned to the October 1, 2013 date. While providers don't have a choice in the date they do have a choice in how they approach the conversion. ICD 10 conversion is not just an IT project--it needs broad and executive-level sponsorship because it will touch multiple departments, processes and systems.
An important first step is to assess the impact of ICD 10 conversion by inventorying those affected policies, processes and systems. Another early task is to identify the risks of non-compliance, and then to assess the likelihood of the risk, its severity and your organization's culture of risk tolerance. This analysis will help you develop appropriate mitigation strategies. A confounding factor is the need to rely on a myriad of partners and vendors to schedule and execute the conversion activities. This is another reason to start early.
ICD 9 is used for a variety of purposes beyond billing. Problem List requirements for Stage 1 of Meaningful Use, for example, specify ICD 9 or SNOMED. The processes for capturing and reporting on the National Hospital Quality Measures, (e.g., deciding which patients are candidates for specific treatments such as providing aspirin on admission) are based on pages and pages of ICD 9 codes. The change management effort related to the ICD 9 to ICD 10 conversion will really hit home when you consider the work of re-designing the reporting based on ICD 10.
Most provider organizations have a line item for ICD 10 in their budgets and likely an ICD 10 placeholder in the planned project queue. Healthcare providers should be encouraged to start their assessments sooner rather than later so they can plan appropriately and accurately size the effort. Most ICD 10 budget estimates and project placeholders are likely light. Given the end date is fixed, under-appreciation of the necessary time and resources can be a critical mistake. The change management challenges will be substantial and resource intensive.
We encourage providers not to consider ICD 10 as a compliance project, but an opportunity to capture more granular clinical data that could aid in improving health outcomes. That said, you can and should leverage your HIPAA experience in leading ICD 10 assessment and remediation programs. ICD 10 conversion will be an effort with the enormity of HIPAA and Y2K combined.
About the Author:
Tim Jenkins is the co-founder of Point B, a leading management consulting firm headquartered in Seattle, WA. For more information about our ICD 10 conversion and consulting services, visit our website.
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