Healthcare reform has brought with it a number of changes that affect how healthcare services are delivered and accounted for. Among the most complex changes is the implementation of the ICD-10 coding and billing standards. The new standards will eventually be required on all healthcare providers covered by the Health Insurance Portability and Accountability Act (HIPAA).
Here are six things you need to know about ICD-10:
1. Worldwide Standards
The ICD-10 standards are neither new nor unique to the United States. They are a set of standards developed by the World Health Organization in the late 80s and early 90s. ICD-9 standards were developed in the 1970s. The ICD-10 standards to be used in this country are a modified version technically known as ICD-10 CM (US). The “CM” stands for “clinical modifications.”
2. Physician Services Are Not Affected
The implementation of ICD-10 primarily affects hospitals and their inpatient services. Physicians and facilities providing outpatient care will continue to use Current Procedural Terminology (CPT) codes. As a practicing physician, you may need to be cognizant of both standards depending on the type of assignments you accept.
3. 2015 Deadline
The original deadline for the implementation of ICD-10 was October 2013. A number of unforeseen complications caused the US government to push back the deadline twice. According to the Centers for Medicare & Medicaid Services (CMS), the new deadline is October 1, 2015.
4. ICD-10 Is More Complicated
We have known for a long time that the implementation of ICD-10 would bring with it significantly more codes. Revenue Cycle e-Learning says the new standards introduce more than 125,000 additional diagnosis and procedure codes. In addition, tens of thousands of new terms will be introduced. Healthcare facilities will have to retrain multitudes of coders and billers.
5. No Clear Transition Plan
Unfortunately, there is no single road map for transition from ICD-9 to ICD-10. This is one of the primary reasons behind the multiple delays. Review Cycle says that in some cases, a one-to-one mapping is possible. In other cases, cluster mapping may be required to take into account combinations of codes or new code sets. There may be a learning curve for locums working at hospitals.
6. Long- and Short-Term Effects
In the long term, implementation of ICD-10 should result in more accurate billing, better reimbursement rates, and better patient outcomes through more detailed diagnosis, treatment plans, and patient tracking. In the short term, healthcare facilities could experience a significant drop-off in productivity among coders and billers.
Healthcare facilities have been granted a reprieve from the ICD-10 deadline until fall of next year. However, you should already be preparing for the transition now. If you are not sure what to do as a locum tenens physician, your staffing agency can help guide you in meeting your responsibilities.