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Conclusions from a new study on the transition to ICD-10 diagnostic codes:

If ICD‐10‐CM were to be mandated as the code set to replace ICD‐9‐CM, it would have a significant effect on both the business and clinical processes of physician practices and clinical laboratories.  The impact is expected to be greater than the impact of the NPI changes or the initial HIPAA changes,because virtually every aspect of the business – documentation, quality measures, coverage andpayment policies, etc., would be affected by the of changing the coding of diagnoses to a greater specificity.

This change will have some one‐time costs, such as training for most staff, changes to superbills to include ten times as many codes, upgrading IT systems for the new code set and changing templates, and reviewing insurance plan contracts for changes to payment  and coverage.  The size of a practice and vendor costs play a major part in the   overall cost of this transition.  Total costs can be expected to range anywhere from around $83000 for a small three person practice to the millions for the very largest practices. In addition to the one‐time costs involved, there will also be permanent additional costs. The greater specificity of the ICD‐10‐CM code set will require more specific documentation in provider records.  This will take physicians additional time, adding about 3‐4% to their  workload.  Again, this is a permanent increase.

For clinical laboratories, besides the changes in IT systems and training, they will be faced with additional difficulties of getting the correct code from ordering physicians.  While a relatively small problem today, any increase in incorrect or missing coding will have a significant impact on both their workload and cash flow.

Physician practices and laboratories face additional issues which will delay their implementation. Much of their documentation and insurance decisions are driven by the coverage and reimbursement policies of health plans. These policies will change to be based on the more specific ICD‐10‐CM codes.  Practices will have to wait to see these changed policies before making their business process changes. Therefore, much of their work will have to wait for health plan decisions.

Should the change be made, it can be expected that there will be a significant learning curve for providers in the documentation and coding of diagnoses in ICD‐10‐CM. This will cause payment delays and claim rejections, probably for at least a year. The cash flow of practices will thus be negatively affected.

See my previous post on ICD-10 codes here. Thanks to Government Healthcare IT.