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ICD-10 and the Impact on Revenue Cycle
October 1 2013, was to mark a seismic shift in the healthcare landscape. On this date, the U.S. government was set to retire the more than 30-year-old International Classification of Diseases, 9th Revision (ICD-9) diagnosis coding standard and officially adopt its successor, ICD-10, for ambulatory services and inpatient discharges.” While the Department of Health and Human Services recently announced they will be extending this deadline, now is still time to act.
While ICD-9 is a limited structure, ICD-10 is expansive, allowing for previously unseen precision in coding, billing, and reimbursement. For instance, rather than processing a simple diagnosis of “fracture of forearm,” healthcare providers will be able to get as detailed as a “torus fracture of lower end of right radius, subsequent encounter for closed fracture with routine healing” thanks to ICD-10’s
Being able to chart, measure, and bill against such intricacies will have long-lasting benefits for the healthcare
industry, including better patient follow-up, more accurate claims, insight into population health, analytics about pan–healthcare system diagnoses, and a decrease in fraud.
To get to this coding nirvana, the healthcare industry has to start preparing for ICD-10 now. The cutover will impact critical systems including electronic health records (EHR), billing, encoding, referral management, contract management, and test
ordering. Peripheral systems such as decision support, quality management, disease
management, clinical trials and protocols, and modeling/trends also must be upgraded to take full advantage of the new coding structure.
According to the mandating agency, the Centers for Medicare & Medicaid Services (CMS), the healthcare industry, including physicians, hospitals, insurance providers, and third-
party billers, should already have started down the ICD-10 path. CMS published a timeline recommending that the first phase of ICD-10 deployment—assessment and planning—be completed by the second quarter of 2011 and that organizations should now be well into implementation preparations.