The healthcare industry has expressed some nervousness regarding the switch to ICD-10 diagnostic and procedural coding system. The switch from ICD-9 represents a massive shift in the way that medical claims are coded and billed. How will this universal change impact the healthcare landscape from the business side?
Coding of Services
The most straightforward change for healthcare providers is the coding of services. The shift to ICD-10 implementation was delayed a few times, but ultimately went through on October 1, 2015. This means that services performed before October 1, 2015 should have been coded using the ICD-9 set of codes, of which there are about 13,000. Services performed after the implementation date should be coded using ICD-10 coding, of which there are about 68,000.
Confusion and Payment Delays
Unfortunately, many providers began using ICD-10 coding before the deadline and many were unprepared for the switch and still coding using ICD-9 guidelines after the deadline. This confusion has inevitably contributed to delays in claims payments. While these delays have not been overwhelmingly detrimental to most hospitals and large offices, some private practices have been impacted severely. Some private practices may not be able to weather the delays and may end up closing.
Changes to Medical Billing Processes
Since the ICD-10 coding requirements differ so dramatically from the requirements of ICD-9 coding, many healthcare providers will have to change their medical billing processes in order to make the change work. In-house medical billing is unrealistic for many providers that are used to operating this way, so many have begun to outsource medical billing for the first time. Others will have to invest in new medical billing software, as many older systems are outdated and incapable of being updated.
Future Benefits of ICD-10
While the ICD-10 switch has caused and will continue to cause some growing pains, the change is expected to ultimately be very beneficial. Other countries use ICD-10 coding, so the shift will help to create a more universal language for healthcare coding and billing. U.S. was the last industrialized nation to adopt the new system of coding. The increased variety of codes will also better accommodate future technologies, medical procedures, and diseases.
Code Specificity and Wiggle Room
The greater specificity of the ICD-10 codes may eventually help with medical research and improve outcomes. While individual medical records are sealed, the more specific codes may be used to ascertain the prevalence of certain diseases in certain areas. This and other patterns and data identifiable by the codes may be helpful in pinpointing causes of disease and finding ideal treatment methods. At present, however, the coding requirements have been relaxed slightly, allowing some leeway in coding specificity as providers adjust.