Conversion of ICD 9 to ICD 10: After Effects

The ICD transition, which has been delayed for a long time, is now mandated by the Center of Medicare and Medicaid services to provide more laterality and specificity to the medical coding system. Also, the new ICD 10 code sets are considered to be more specific and accurate in diagnosis, thus providing higher quality of care. It has been crucial for healthcare organizations to prepare well for the conversion of ICD 9 to ICD 10 in order to avoid expensive delays / penalties. After numerous delays and anticipation, ICD 10 has been finally implemented on 1st of October, 2015. This transition passed without any major glitches in the healthcare space. Health insurers, providers and large healthcare institutions are monitored closely for any interruption in the cash flow between providers and payers. 

Conversion of ICD 9 to ICD 10

Although the conversion of ICD 9 to ICD 10 adds better specificity to diagnosing clinically severe ailments, the first two weeks of ICD 10 implementation saw a slight unstick in the claim denials related to the new ICD 10 code sets. CMS reported that there was only 0.09% increase in the claim denial because of invalid ICD codes. However, the Center of Medicare and Medicaid Services has released a report on October 20th, 2015 regarding the performance of physicians, payers and the medical coders where we can see few issues faced by all the entities of the healthcare sector.

Providers Distracted

Providers and doctors feel that ICD conversion and implementation has been a challenge that also disturbs their day to day operations. Sermo, a physician’s social networking platform reported that 86% of the physicians surveyed out of 200 for ICD 10 conversion feel that the conversion is taking more time than providing patient care.  They also feel that using new code sets will allow the industry stakeholders to accurately and better track the patient outcomes, and manage the quality of care, which is a move towards the patient centricity.

Payer Problems

An increased number of procedural codes and associated diagnosis codes have majorly impacted the preauthorization by payers, ending up in denying claims due to the incorrect ICD 10 codes used by the providers. CMS states that almost 60% of the prior authorizations have the wrong ICD 10 codes submitted, causing a significant strain to the payers, providers and other members involved. Payers are also taking measures to eliminate the code variations in ICD 10, which are causing disparities in reimbursement. i.e. payers do not want to overpay or underpay the providers because of the inaccurate and unsuitable ICD 10 codes used by the providers.

Coders’ Productivity

Hospitals and outsourced coding organizations have witnessed a decreased productivity in the month of October 2015. The main reason being, unfamiliarity with the new ICD 10 code sets, increased complexity and lack of confidence in implementing the new code sets. Making a precise estimate on how largely the new code sets are impacting the coders is difficult. Healthcare Information and Management Systems (HIMSS) has come up with metrics and mitigation strategies to help the hospitals and the coding companies to deal with the productivity issues. However, these mitigation strategies can only bear a temporary impact. The coding productivity can be only recovered and be consistent after a year or two of experience in ICD 10 coding.

Organizations, providers and healthcare institutions should determine their needs and see how they can best utilize the new code sets to stay competitive in the market. However, the healthcare market still needs some time to settle the dust of ICD transition. With the new code sets, one can measure the quality of care, better track the diseases, and precisely evaluate patient outcomes – all of which definitely is a shift towards value-based payment plans. Ultimately, better and accurate coding will result in better data across the healthcare industry, which shall be a boon to payers, providers, as well as healthcare IT companies.


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About the Author

Shruthi Bhat is serving as an Associate Business Analyst for Healthcare and Insurance vertical at SPAN. She is an active contributor to SPAN’s insurance customer newsletter and blogs. Her areas of interest include researching on current or upcoming trends in the Healthcare and Insurance market, Analytics etc.  She holds a Master’s Degree in Business Administrations from Manipal University.

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