Is ICD-10 A Trick Or A Treat?

Is ICD-10 A Trick Or A Treat?

For those lovers of all things Halloween related, failed vampire attacks would likely be covered by “S10.87XA: other superficial bite of other specified part of neck” in the new specificity requirements of ICD-10 implementation. The end of the flexibility of CMS for full implementation of ICD-10-CM is the latest challenge for healthcare organizations on the anniversary of adoption of the new coding guidelines in the United States. If you are not in the revenue cycle or medical records side of healthcare, you might ask, why the melt down for professionals in the industry? Why do adjectives associated with implementation include looming, disastrous, and burdensome with a fear of increased physician retirement if all does not go well?

Simply put, take a healthcare system that is in a word fractured, and transition from approximately 13,000 codes to 68,000 codes and eliminate the grace period of full implementation. An interesting side note is a review of some of the truly ‘entertaining’ codes, for anyone wanting a departure from doom and gloom.

To gain a more complete understanding of my notes of caution, not only have the number of codes increased dramatically, but the structure has also changed. ICD-9 codes were 3-5 characters in length and allowed the first digit to be alpha or numeric, and digits 2-5 were numeric. ICD-10 codes are 3-7 characters in length, and require the first digit to be alpha, digits 2 and 3 numeric, and digits 4-7 can be alpha or numeric. (Can I get a roll of the eyes here please?) In other words, start completely over and as of October 1, 2016, no more grace period from CMS to get it right. If it’s wrong, the result is a denied claim and therefore the delay in revenues received. Add to that, the additional 2017 update that brings the total count to 75,625 codes required to be used for accurate billing and receiving reimbursement.

All eyes will be on 2017 revenue cycle outcomes. With other survey data reporting that 33 percent of those polled experienced a 20% decrease in revenue (more codes means more time to process), another increase in the number of codes and an elimination of CMS accepting codes that are “close enough,” the impact on an overburdened healthcare system may have been simply a delay in significant impact.

One year ago, the ICD-10 implementation was by all reports a ‘non-event’ despite (for those of you who are old enough to remember) having the same doom and gloom Armageddon anticipation as Y2K, with the same result. The world as we know it did not spin off its axis. The reality however, is that the true picture is yet to unfold. The denial rate for the first phase with grace period did not increase over the prior year. It is only $12.9 billion dollars …. think about that number for a moment. I realize that in the grand scheme of things, it is only 1.9% of total claims submitted, but that is still a big chunk of change! It is truly indicative of the huge business that healthcare has become.