Will ICD-10 be Worth It?

It’s a question that must be asked: Will the expense – in terms of time, manpower and money – someday pay off by improving the quality of care in America?

As long as the list of grievances runs, the collection of potential benefits – ways that ICD-10 and its seven-digits can bolster healthcare – carries on as well. The overarching advantages can be boiled into a reduction sauce: Higher-quality data of greater specificity for reporting, trends and analysis that will ultimately lead to better health outcomes for individuals and populations.

Much of the rest of the world has gone to ICD-10, and it’s high time the United States catches up. But for the rewards to fully materialize, every physician and provider has to code in ICD-10 and submit claims in ICD-10 to payers that are also in compliance with the new code sets.

“The advantages of the ICD-10 code sets will not be realized unless providers document thoroughly and bill with codes representing the services delivered and the patient’s clinical status,” said Pat Zenner, healthcare consultant at Milliman. “That will only occur when providers can realize ‘what’s in it for me.’”

[See also: ICD-10's day of reckoning, the HIPAA 5010 compliance deadline.]

CMS maintains steadfastly that Oct. 1, 2013 is a firm cutoff date on which the switch will flip to ICD-10, and holds itself up as a pilot project that will deliver on time. The agency, as recently as August, reiterated in a National Provider Conference Call that it “does not intend to delay Version 5010 or ICD-10 implementation,” and instead is “committed to meeting these regulatory compliance deadlines, and expects the industry to do as well.”

But rumors are swirling that some state-level Medicaid agencies – California, Illinois and Pennsylvania among them, according to Arges – won’t make the deadline. “We’re very concerned right now with some of the state Medicaid programs and where they might be in terms of readiness for ICD-10, and that is a problem because what we don’t want to happen is to force providers into dual reporting, to code in ICD-9 for some Medicaid plans and code in ICD-10 for everybody else,” Arges said. “That is the worst of all worlds because it adds to the inefficiency and it penalizes people for making the steps they’re taking today to get ready for ICD-10.”

Even with thorough planning, anticipating all the changes ICD-10 will bring is near impossible, if only because there is no way to accurately predict how providers will document and use the code set, Zenner said. “It is important to realize where the level of uncertainty is greatest, and build protections to help mitigate the impact of the unknown,” she cautioned.

Indeed, such uncertainty is why so many health experts are concerned that the federal government has not conducted a satisfactory test pilot to blaze the trail, look back and guide the rest of the industry in the right direction.

“We have a big mess on our hands and there’s no doubt there will be a heck of a lot of money spent on IT, so a lot of the folks at Cisco, IBM or Microsoft, there’s going to be a lot of money for them to make,” Graham said. “Whether it will be productive to the healthcare system, well, that’s a completely different question.”

It’s also a question that won’t likely be answered anytime soon. Whether ICD-10 wreaks havoc on healthcare or ultimately proves its worth may take years to unfold.

“Some organizations structure their ICD-10 implementation efforts to end on Oct. 1, 2013 or shortly thereafter, but the real opportunities with ICD-10 will come in the post-compliance period,” Zenner said. “Organizations need to plan for how they will evaluate these programs during the transition period – which, from a data perspective, will last several years."

And so the fire that began as early as 2004 will burn fierce and hot into 2014, and after.