Expert says ICD-10 implementation is critical - and expensive

Virtually all technologies and processes in a hospital will be affected by the conversion of the nation's disease code sets from ICD-9 to ICD-10, according to Cynthia Grant, director of Courtyard Group, a Canadian consulting firm. "If you think this will be a software update, think again," she said.

Grant spoke to healthcare executives Thursday at the College of Health Information Management Executives' Fall CIO Forum in Phoenix. Her comments were certain to create headaches for the executives whose organizations are now embroiled in the changeover, but she pointed out that the conversion is long overdue and necessary to bring America's healthcare system up-to-date.

The move to ICD-10 translates into millions – possibly even billions – of dollars in costs. Providers will incur costs for computer reprogramming, the training of coders, physicians and code users, and for the initial and long-term loss of productivity among coders and physicians, according to the RAND Science and Technology Policy Institute. RAND estimated the one-time cost of conversion at $425 million to $1.15 billion, plus somewhere between $5 million and $40 million a year in lost productivity.

Grant warned that some hospitals might not see the same productivity after the conversion to ICD-10.

All care providers and payers will have to adopt the ICD-10 coding by Oct. 1, 2013.

"It's a pretty dramatic thing that's going to happen on that date," Grant said.

The International Classification of Disease code system is used for billing and clinical classifications. The number of codes will jump from about 17,000 under the ICD-9 system to more than 150,000 with ICD-10.

The difference between ICD-9 and ICD-10 is "like apples and beefsteak," Grant said. "I can't even compare it to another fruit."

Proponents of ICD-10, such as the American Health Information Management Association and the American Hospital Association, say the new codes will bring the healthcare system into the 21st Century. They say ICD-10 will also replace an inneffective ICD-9 code set that:

• Lacks sufficient specificity and detail;
• Is running out of space, with a limited structural design that can't accommodate advances in medicine and medical technology and the growing need for quality data;
• Is obsolete and no longer reflects current knowledge of disease processes, contemporary medical terminology or the modern practice of medicine;
• Hampers the ability to compare costs and outcomes of different medical technologies; and
• Can't support the nation's transition to an interoperable health data exchange.

Grant said almost every other country in the world made the switch long ago – the UK in 1995, France in 1996, Australia in 1998 and Canada in 2004. "Other countries are saying, 'Why are they doing that now?'" she said.

In the United States, it's long overdue. And though many countries are already looking to ICD-11 or have implemented it, there's no skipping straight to ICD-11 for the United States.

"You have to go to 10 anyway," said Grant, because 11 is an upgrade.

Grant has led several projects for the Courtyard Group and is leading U.S.-based initiatives in health information management/ICD-10 implementation. Her background is in health information management and coding.

ICD-10, she said, changes everything. A pain in the limb is coded in ICD-9 as 729.5 – but in ICD-10, there are more than 30 code choices.

"You need to know where the pain the limb is, " Grant said, "and also whether it's on the left or the right."

"If you're simply coding pain in the limb – unspecified – you could be leaving money on the table," she added.

Grant said converting to ICD-10 codes allows for better patient care and better quality outcomes. Also, she said, the data set will be richer and lead to more informed decisions.

On the down side, Grant said, Canadian data show that the productivity in Canada after conversion from ICD-9 to ICD-10 never rebounded to pre-ICD-10 levels. More granularity takes more time.

Just how much more time, of course, depends on the size and complexity of the hospital.

Just as it's critical to educate the coding staff, Grant said, it's just as important – perhaps even more so – to make sure that physicians are trained, too.

"They don't need to become coders," she said, but the information needs to be available to the HIM coder. "You can't code what isn't charted."