The Department of Health and Human Services on Thursday released the long-awaited ICD-10 code set and set a new compliance date of Oct. 1, 2013.
The new date gives providers, now using the ICD-9 code set, an additional two years to prepare for compliance which experts are contending will be costly and time-consuming.
According to a study initiated by a broad group of provider organizations and conducted by Nachimson Advisors, the cost for a 10-physician practice to implement ICD-10 is estimated at more than $285,000. This includes the cost of training expenditures, new claim forms software, business process analysis, practice management and billing software upgrades, increases in claim inquiries and reduction in cash flow and increased documentation costs.
For a small, three-physician practice, the total cost to implement ICD-10 is estimated to be $83,290, the study said. For a large, 100-physician practice the estimated cost of implementation is more than $2.7 million.
Groups supporting the study and a delay in the original compliance deadline of Oct. 1, 2011 include the American Academy of Professional Coders, American Clinical Laboratory Association, American College of Physicians, American Medical Association and Medical Group Management Association.
Experts from the American Academy of Professional Coders said the transition to ICD-10 will require doctors to learn a more extensive way of documenting their work, or they could face losing reimbursements.
"The increased granularity of the coding and the sharp increase in the complexity and number of codes themselves will be `pretty stunning,'" said Sheri Poe Bernard, head of the American Academy of Professional Coders' national advisory board. "The last time we had anything this big was 30 years ago when ICD-9 codes were first required on paper claims."
HHS also released Thursday an updated X12 standard, Version 5010, for certain electronic healthcare transactions; an updated version of the National Council for Prescription Drug Programs (NCPDP) standard, Version D.0, for electronic pharmacy-related transactions; and a standard for Medicaid pharmacy subrogation transactions. HHS extended the deadline for X12 standard, Version 5010 by 21 months from the date set in the proposed rule, to Jan. 1, 2012. Small health plans have a compliance deadline for X12, Version 5010 of Jan. 1, 2013.
According to HHS officials, Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization and other administrative transactions. It also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard.
"These regulations will move the nation toward a more efficient, quality-focused healthcare system by helping accelerate the widespread adoption of health information technology," said HHS Secretary Mike Leavitt.
According to Leavitt, adoption of the ICD-10 code set is expected to support Medicare's value-based purchasing initiative and antifraud and abuse activities. ICD-10 will also allow the United States to compare its data with international data to track the incidence and spread of disease and treatment outcomes. The United States is one of the few developed countries not using ICD-10.
According to Kerry Weems, acting administrator of the Centers for Medicare & Medicaid Services, HHS received more than 3,000 comments on the proposed ICD-10 rule, with strong support for the transition and requests for a delay in compliance dates.
Some groups were not happy with the deadline extension. The American Health Information Management Association said the extension will mean "more years without the data needed to make intelligent data-driven decisions related to all aspects of healthcare."
AHIMA officials said despite the extra time HHS has granted, providers should start now to make the transition.
