ICD-10 Transition Update

ICD 10 | Mile High Healthcare Analytics

Despite much nail biting and teeth gnashing in anticipation of the cutover to ICD-10, the apocalypse appears to have been avoided. To many in the industry, the October 1 transition to ICD-10 created a Y2K-like frenzy, and, like Y2K, it appears to be mostly a non-event.

ICD-10 Code Quantity Explosion

That is not to downplay the significance of this transition. The new ICD-10-CM diagnosis coding scheme contains 68,106 codes which is more than a 400 percent increase over ICD-9. It also offers a substantially greater degree of granularity for the coding of selected conditions. For example, the diabetes HCCs could be resolved choosing from an array of 69 codes in ICD-9, but providers now need to choose from 132 codes under ICD-10. To some, this explosion of new codes borders on the ridiculous. For many of the top HHC codes, however, the number of codes has not changed dramatically. Depending on a physician’s specialty, the impact of the transition can be very different. For instance for, HCC058, Major Depression, the number of codes increased by 644% from 109 to 811, while on the contrary, the number of codes for HC085, Congestive Heart Failure, only increased by 7% from 43 to 46.

Navigating the Transition

Thankfully, after two weeks, payers, large medical groups and government agencies appear to be managing the transition successfully. Smaller practices where the medical staff typically enters the codes, have had a more difficult transition. Many complain that the new system is requiring significant extra time per patient and negatively impacting patient care. In fact, one practice estimated that it now takes an extra 60-80 minutes per 12-hour shift to enter the appropriate codes.

That being said, the relative success of the transition is in part due to the extended preparation lead time. ICD-10 was originally set to go live two years ago, but was postponed twice. Expanded penetration of EMR implementations has also eased the burden of the ICD-10 transition. According to statistics released by the NCHS last year, the percentage of physicians using any EHR system increased by 168% between 2006 and 2013 from 29.2% to 78.4%. And nearly half of physicians (48.1%) were using the more comprehensive “basic system” by 2013, up from 10.5% in 2006.”

Impact of ICD-10 on Risk Adjustment

While ICD-10 is going to impose a substantial new burden on the coding process, particularly in the outpatient office setting, its impact on actual risk adjustment calculations should be modest. According to a CMS/AHIMA impact study the transition to ICD-10 will have a high a big impact on the systems involved in the Risk Adjustment Process, but not on the actual outcome. Each system and interface must be evaluated to determine readiness to support the transition to ICD-10. CMS and Medicare support contractors will need to target areas such as field character length in databases, formulas, calculations, reports and application user displays.

No matter where you sit within the healthcare ecosystem, the transition to ICD-10 is not an easy one. If you have concerns about your organization’s readiness, the experts at Mile High Healthcare Analytics can help you audit your current processes. With our Risk Adjustment Advisory Service we can conduct an end-to-end analysis of your commercial, Medicare-Advantage or Medicaid risk adjustment program to make sure you’ve made the changes required based on the ICD-10 transition. Contact us today at 720-446-7785 or mhh@healthcareanalytics.expert to learn more.