ICD-10 Delay Could Cost Doctors & Healthcare Vendors Billions


Senate majority leaders passed a vote pushing the deadline for ICD-10 implementation to October 2015, estimated by some to cost between $1-6 Billion to healthcare vendors.

As of April 1st, 2014 the “Protecting Access to Medicare Act of 2014” (PAMA) had passed and was supposed to require all healthcare providers covered under HIPAA to use the new ICD-10 coding system effective October 1st, 2014. However, this one-year delay in implementation will have serious impacts on ROI’s for major shareholders. It is estimated that approximately 20,000 students exclusively trained for medical coding in the new ICD-10 system will be directly affected.

The new ICD-10 system, also known as the International Classification of Disease10th edition, is a much-needed change to the way doctors and healthcare facilities code for medical diagnoses for disease classification. In the past, ICD-9 coding, a system designed over 30 years ago, utilized a 3-5-digit number to specify a diagnostic or procedural code. Under the new ICD-10 coding system, according to the CDC, will utilize a 3-7 alphanumeric code allowing greater specificity by incorporating over 68,000 new procedural codes as well as 55,000 new diagnostic codes to be used. What was once a limited set of codes that did not include important data about a patients’ past medical history or inpatient hospital procedures, will now in a field with an ever-expanding pool of new disease and treatment options give the ability to code with a much higher degree of specificity.

The financial impact of the transition can be devastating to small or medium sized practices. Athena Health, one of the larger vendors in the sector, estimates pre-implementation costs for small and medium size practices ranging from $300,000 and up to over $8million for larger sized practices. That does not include delays such as this push to 2015. Wasted resources training personnel, potential errors in claims processing and a lack of a coordinated appeals process all can contribute to money wasted with this delay.

The American Podiatric Medical Association said in a statement "While the delay does allow for additional time for preparation, it poses a significant financial and resource impact on entities that were heavily invested in the transition” (Source: Bresnick, EHR Intelligence, 3/31).

This major change will be difficult and require doctors and hospitals to start implementing a plan to modify current charting protocol or coding software prior to the deadline next year but will result in higher efficiency and better accuracy once complete.

By Kevin Kleiner, M.B.S.