ACCA: Get on the ICD-10 bandwagon, NOW

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CHICAGO—Hospitals must implement a contingency plan to deal with ICD-10, said Mary Phelps and Carol Beehler, both of PricewaterhouseCoopers during a presentation March 22 at the annual meeting of the American College of Cardiovascular Administrators (ACCA). Hospitals should go forward preparing for ICD-10, despite the fact that the Oct. 1, 2013, deadline has been delayed.

“The U.S. is way behind the times,” offered Beehler, who said that the ICD-9 code set is 29 years old. The ICD-10 code set, adopted in 2004, has been adopted by nearly every other country—minus the U.S.

“We need to get with the numbers,” Beehler urged. The specificity and granularity that will be included in ICD-10 will move care forward and allow the healthcare system to account for the changing procedures and innovative technology.

“There is a lot of capacity in ICD-10 to expand the codes,” Beehler said. She said that providers should ask themselves, “What if ICD-10 did happen on Oct. 1, 2013?”

Phelps added that providers must outline approaches on how to transition toward ICD-10. “While some providers have not yet looked at ICD-10 [58 percent according to a recent AHIMA study], payors are looking at this closely.”

“Hospitals tends to wait until there is a fire and wait to put it out,” Phelps said. But for ICD-10, hospitals will need a long-range plan, she said.

Providers must follow the code framework, which includes four aspects:

  • Arranging the care (scheduling);
  • Delivering care;
  • Accounting for the care (coding/documentation); and
  • Managing the care (reporting it).

“The entire ICD-10 process will be wrapped in IT,” Phelps noted, and a vendor analysis will be necessary.

Additionally, providers should “know their number,” which is the top ICD-9 codes they are using. “Twenty percent of your claims drive 80 percent of your business,” Phelps noted. Therefore, providers must look at the codes they use most frequently.

When Canada implemented ICD-10 it saw a 30 percent decrease in workflow productivity, which it never got back, Phelps said. “However, Canada does not use coding for reimbursement like the U.S. does."

Phelps called ICD-10 the “elephant in the room” and urged that providers start preparing now. She offered that administrators should start with scheduling and evaluating the financial implications of switching to ICD-10.

Administrators should also:

  • Identify the level and amount of staff training necessary;
  • Assess the need to redesign procedure descriptions;
  • Collaborate with the health information management department on new requirements; and
  • Understand what it means for physicians working in departments to evaluate productivity and impact on volumes.

“You need to incorporate a contingency plan,” Phelps summed. “You can’t do this all at once; you must cut it into phases and bite off a little bit at a time. You will have errors if you don’t start planning now.”