ICD-10: Healthcare's New Y2K

By Ken Congdon, editor in chief, Health IT Outcomes

Twelve to fifteen years ago the IT community was abuzz with Y2K activity. IT departments around the world were busy updating their systems in preparation for the new millennium, ensuring computer systems were equipped to account for the date change to '00. Unlike other IT projects before and since, there were no floating deadlines with Y2K. It was a race against time, and failure to complete required system upgrades by the moment the big ball dropped in Times Square had potentially catastrophic consequences.

The healthcare industry is now facing another Y2K of sorts in ICD-10 — a transition from the current ICD-9 medical diagnosis code set to new ICD-10 codes. However, many healthcare facilities have failed to appreciate the importance, size, and scope of ICD-10 until recently — an exercise in procrastination that may prove disastrous. One can hardly blame healthcare facilities for delaying their ICD-10 initiatives, though. After all, most have been keenly focused on implementing and perfecting their EHR systems to comply with federal government mandates and incentive programs. Y2K never had to compete for the time and attention of IT resources with such a grandiose technology initiative. The problem with this prioritization is that ICD-10 actually has a tighter deadline (October 1, 2013) than EHR adoption and Meaningful Use (2014/2015).

Many health IT leaders would cite project complexity to defend their prioritization of EHR system deployment over their ICD-10 initiatives. While this reasoning may be accurate, one should not underestimate what's entailed in a transition to ICD-10.

• ICD-10 involves a substantial increase in the number of codes. Whereas ICD-9 consists of more than 14,000 codes, ICD-10 consists of nearly 70,000 — that's an increase of more than 350%.
• Moreover, codes are now much more granular under ICD-10. In ICD-9 there was only one code for angioplasty. In ICD-10, there are 1,170 — each code pinpointing the location of the blockage and the device used in the procedure.
• Code format is also changing under ICD-10. ICD-10 diagnosis codes can be up to 7 characters in length, whereas ICD-9 codes could only be 5 characters long.
• An ICD-10 upgrade requires more than just a change to your coding system. Any IT system that stores, analyzes, or processes code values must be updated to recognize the new ICD-10 code set. This includes financial, claims processing, and customer reporting tools.
• Furthermore, since no healthcare facility is likely to do a clean switch over from ICD-9 to ICD-10, each of these systems will need to be able to accommodate and translate both code sets simultaneously for some period of time.

Prepare For ICD-10 Or Face The Consequences

With the average cost of an ICD-10 transition ranging from $2 to $5 million for a single hospital, and as much as $20 million for a large integrated delivery network, ensuring the initiative is successful is important. According to industry experts, preparation is key.

"Healthcare facilities embarking on an ICD-10 transition should prepare an inventory of all software, paper, people, and processes that use diagnosis codes," says Ken Bradley, VP of strategic planning at Navicure, a provider of web-based accounts receivable solutions. "This will allow you to prepare an action plan for handling the switch to ICD-10 and involve the people and systems who are directly and indirectly affected. Forming a joint team of both clinical and administrative personnel to conduct the assessment of where and how diagnosis codes are used can also help you prepare for ICD-10 changes."

Remember, like Y2K, ICD-10 carries with it a hard deadline of October 1, 2013. Thus far, no grace periods or extensions have been mentioned. However, unlike Y2K the consequences for noncompliance won't result in the inadvertent launch of nuclear missiles, planes falling from the sky, or a mass erasure of credit histories. Instead, any claims for services made after this date using the old ICD-9 codes will simply be denied or rejected and you will not be paid — a prospect that is just as terrifying to most healthcare providers.

For more information on ICD-10, check out the following content:

Podcast – ICD-10: Ready Or Not?
White Paper: Preparing For ICD-10: Evaluating Approaches And Potential Pitfalls
Article – ICD-10: A Tale Of Two Coding Systems

Have a comment or feedback for Ken on this article? He can be reached directly at ken.congdon@jamesonpublishing.com.