The Affordable Care Act has caused quite the stir on both sides of the political aisle, but for the sake of this article, we’re not going to get into politics.
We’re more interested in how the legislation impacts health care technology. As modern medicine further integrates with digital technology, Obamacare’s wide-sweeping effects will be felt in more areas than just people’s insurance plans. The way health care organizations and other industry stakeholders collect, process, and store patient data is progressing, which means the same parties need to convert from ICD-9 to ICD-10.
On the surface, it sounds easy enough. What’s the big deal? Well, think again.
The International Classification of Diseases, Ninth Revision, is based on a set of standards set by the World Health Organization. It accesses a database of diagnosis and procedures codes associated with hospital use. More simply put, it’s a shorthand way of logging certain ailments or procedures patients have or undergo when they visit a hospital. For example, the code for strep throat would be 034.0 under ICD-9 regulations. These codes are globally mandated, which provides a level of parity in the healthcare industry.
Under the ACA, healthcare providers have to upgrade to ICD-10 codes, which are more descriptive and complex. Currently there are 17,000 codes under ICD-9; under ICD-10, health care providers are responsible for mapping 188,000 codes. That's quite the conversion, isn't it?
Industry stakeholders and providers face a challenge to meet the upcoming Oct. 1 deadline, a date that was extended by a year in 2014 after parties involved said they didn't have enough time to implement the right infrastructure and transition accordingly. One of the largest pain points stakeholders currently face is implementation because mapping from ICD-9 to ICD-10 requires extensive work and investment. All existing electronic medical records have to be transitioned or modified with the new codes — and done so correctly.
The motives behind ICD-10 conversion are to make patient health information more specific and accurate, which could end up helping insurance companies, doctors and the like. However, the expense in making sure the right implementations are made is quite large, and besides...who is responsible within each entity for making these changes anyway? What’s more, who has the right skill set to update ICD-9 codes to ICD-10? And what happens if the information is inaccurately transitioned from one to the other?
The healthcare industry is scrambling to get their cards in order before Oct. 1. For example, for any financial transactions that are made, the claims won't be paid to the hospital if they aren’t up to date with ICD-10 coding. The move is aimed at improving recording and logging accuracy, but it could create confusion if there are any mistakes made during the transition process. If something isn’t properly documented, insurance providers won't reimburse healthcare providers, creating tension between the two parties.
That said, IT will play a vital role in the upcoming conversion. Someone has to go in and change the coding since there is no mapping right now to automate changes between ICD-9 and ICD-10, since they’re completely different and ICD-10 is more specific. Purely in terms of integration, there’s a cost almost every step of the way. Who will do the mapping? Who is responsible for understanding the new codes? What types of software solutions are needed to be compliant with the upgrade?
If you’re in the healthcare industry, there are a lot of questions your organization must ask itself before next October. There are likely a number of integration challenges heading your way, but with the right amount of planning, you can meet these hurdles head on. For now, it’s critical to know how you will accurately transition existing codes into the new ICD-10 coding, because it will end up saving you lots of time and money down the road.