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Coding system coming in ’14 will change parts of health system

Imagine that starting Oct. 1, 2014, every publishing company in the United States had to use Swahili for all official business.

Swap in health care for publishing, International Classification of Diseases Tenth Revision for Swahili, and medical billing and coding for official business — and it’s true.

“It will be huge,” said Lisa Hershey, program director of the medical billing and coding programs at YTI Career Institute’s Lancaster campus. “The change from ICD-9 to ICD-10 is the largest change in the billing and coding industry in the last 30 years.”

The transition will touch everything from physician documentation to accounting to billing to IT. People preparing for ICD-10 say that, in some ways, it will be as big a transition for the health care community as the switch to electronic health records has been.

ICD-10 isn’t part of the Patient Protection and Affordable Care Act, but the transition will happen concurrently with many major provisions of PPACA.

Dr. James Madara, CEO of the American Medical Association, repeatedly stressed that in a May letter asking the Centers for Medicare and Medicaid Services to push back the deadline and reconsider the decision. CMS announced in August that the 2014 deadline was final.

“This is a massive administrative and financial undertaking for physicians, requiring education, software, coder training and testing with payers,” Madara wrote. He cited “considerable concern” about implementing ICD-10 at the same time as electronic health record systems and said physicians are already overwhelmed with simultaneous implementation of multiple health IT programs.

Furthermore, he wrote, “Depending on the size of a medical practice, the total cost of implementing ICD-10 ranges from $83,290 to more than $2.7 million.”


However, according to Karen Tinney, how much training and preparation will be needed for the transition can vary widely depending on role. Tinney is director of health information services at Ephrata Community Hospital, where a committee has been preparing for ICD-10 for more than a year.

On the inpatient side, Tinney said, physicians fill in charts, which doesn’t require knowledge of specific codes — that falls to the coding department, which gets the charts after patients are discharged. However, ICD-10 requires a lot more specificity: Where ICD-9 had only one applicable code, ICD-10 might have 10 options. Consequently, doctors will have to document in much more detail than they do now.

Heather Stauffer

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