ICD-10 Pilot Has Significant Setbacks

By Katie Wike, contributing writer

The outlook for ICD-10 implementation is bleak if the results of the National Pilot Program are any indication

The results of the HIMSS/WEDI ICD-10 National Pilot Program indicate there is still work to be done if there is any chance for successful implementation. The Pilot Program “was an industry-wide healthcare collaborative which was established to minimize the guess work related to ICD-10 testing and to learn best practices from early adopter organizations.”

HIMSS reports, “This Pilot Testing used standard test case scenarios that were collected, vetted, and developed by ICD-10 National Pilot Program participants. Test case scenarios were:

• De-identified clinical claims; natively coded to ICD-10 by live, certified ICD-10 coders
• Representative of 100-200 of the most common medical conditions in healthcare
• Can be used as a base set for your testing - but may be customized as required
• Available, free of charge, in the HIMSS ICD-10 PlayBook for entities that must test for ICD-10”

EHR Intelligence summarized the report’s results, writing, “The general rate of accuracy when coding test claims in ICD-10 was 63 percent, with the lowest scores for specific codes hovering around 30 percent accuracy. Problems ranged from an over-reliance on computer assisted coding, mixing up similar letters and numbers, and technical glitches with uploading and transmission of documents to issues with overworked coders, incomplete EHR documentation, and coders forgetting key aspects of ICD-10 that were not present in the ICD-9 code set.” Testing revealed coders confused characters like “0” and “O” and forgot to add procedure codes, as well as other low level mistakes.

The report advises, “All ICD-10 impacted organizations should act now to allocate as much time as possible for testing and remediation to protect their corporate bottom lines and cash flow to successfully achieve compliance.” In reaction to the study, HIMSS recommends providers avoid converting ICD-9 codes into ICD-10 codes during training as providers are at risk for financial problems due to discrepancies if the coding is not correct.

The report concluded, “It took the highest level of commitment for all participants to engage their own staff and support this endeavor in light of the many competing priorities, demand for time, and resources. It took enormous effort, time, perseverance, organization, planning, coordination or schedules, orchestration of tasks and activities, creation of a sensible project plan, in-kind donations, and people resources to complete. Program leadership and commitment were key indicators to the success of the program. The pilot program is a decent predictor of what the healthcare industry would need to strive and aim for in order to accomplish the nation-wide ICD-10 conversion successfully.”

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