Effects of the Delay in ICD-10 Implementation

Effects of the Delay in ICD-10 Implementation

Despite the scheduled deadline, another delay on the implementation of the tenth revision of the International Classification of Diseases or ICD-10 codes happened last week. The healthcare industry had been preparing to switch to the ICD-10 code supposedly set on October 1, 2014, but last Thursday, the US House of Representatives has signed a bill that postpones the transition to ICD-10 diagnostic codes for a year or longer.

The bill, H.R. 4302 or the Protecting Access to Medicare Act of 2014, states that the Department of Health and Human Services (HHS) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015. The ICD-10, despite being in the works since 1990s, has been repeatedly pushed back.

Impacts of the ICD-10 Delay

Representatives of the healthcare industry are claiming that additional time is necessary to effectively and properly implement the ICD-10 transition, thus the delay. Whatever the reasons are, the postponement of the ICD-10 implementation will certainly have its negative consequences.

1.    Additional costs.

What makes this recent delay troublesome is that it comes so late in the process – after many organizations have already spent much time and money getting ready for the supposedly immovable deadline.

The Centers for Medicare and Medicaid Services (CMS) has estimated that another one-year delay of ICD-10 would likely cost the healthcare industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay. This does not include the lost opportunity costs of failing to move to a more effective code set, the American Health Information Management Association (AHIMA) said.

2.    Another hurdle to the healthcare system.

The delay directly impacts at least 25,000 students currently studying to work as medical coders – many of whom have learned to code exclusively in ICD-10 in health information management (HIM) associate and baccalaureate educational programs, AHIMA said in a statement.

Many coding education programs had switched to teaching only ICD-10 codes to students, hospitals and physician offices. Even the CMS and NCHS committee responsible for officially updating the current code set changed the group’s name to the ICD-10-CM from PCS Coordination and Maintenance Committee.

3.    Confusion on what coding scheme to follow.

The current coding standard, ICD-9, is already considered by experts as “antiquated and no longer adequately meets the challenge of a 21st century healthcare system,” according to AHIMA CEO Lynne Thomas Gordan.

Another one-year delay of ICD-10 means maintaining two parallel systems — one for ICD-9 and another for ICD-10 — while putting ICD-10 training programs in a holding pattern for the next 18 months. “I would think that would be very difficult for the industry. All of your payers would have to support dual coding systems, which would be very burdensome,” Gordon added.

The delay of ICD-10 also impacts the medical billing codes, population health, and other programs that are expected to start using ICD-10 codes in October.

4.    Next step remains unclear.

So far, the CMS hasn’t said how it will translate the law into regulatory policy. Until today, the regulatory uncertainty has not been cleared up. There might be an outside chance that the CMS might decide to skip ICD-10 entirely and shift focus to the ICD-11 standard currently under development. Regardless, we have to assume the ICD-10 transition is still coming, until we hear otherwise.

Written by Jeff De Jesus

Jeff De Jesus

With his exposure to the outsourcing industry since 2003, Jeff was able to share and implement his leadership insights with respect to managing business process accounts, particularly in the healthcare department. Jeff has also taken part in assessing the fundamentals of the company’s operational processes, utilizing his experience as an Operations Manager across different verticals, identifying and executing methods that can improve the quality of workflow in the company. Jeff’s experience is not only limited to the Healthcare solutions as his capability in handling Customer Support is also mirrored in the successes that the company has achieved.

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