What are the Costs vs Benefits to the ICD-10?

23 Nov

The most recent medical coding, or International Classification of Diseases, is ICD-10. It was endorsed by the 43rd World Health Assembly in May 1990 and was started to be used in WHO Member States in 1994. But it’s not until 2013 that we will see these revisions in the U.S.

So, how does the ICD-10 differ from the ICD-9 set of codes currently in use in the U.S.? The ICD-10-CM codes are very different. All codes in ICD-10-CM are alpha-numeric. There can be as many as seven alpha-numeric characters. This means that billing software programs must be changed to accommodate the additional digits. This also means more extensive medical billing coder training.

While there won’t be much change in how the physician does his or her documentation in the medical records, the translation process into ICD coding will change. The newer codes will provide more detailed information about the patient’s condition.

It’s interesting to see some of the data comparing what ICD-10 will cost versus what it can save hospitals and healthcare providers. The RAND Science and Technology Policy Institute did a cost/benefit analysis of implementing ICD-10. What they found was that providers will incur costs for computer reprogramming, training coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians.

The cost of sequential conversion (10-CM then 10-PCS) is estimated to be between $425 million and $1.15 billion in one-time costs. There will also be between $5 and $40 million lost in yearly productivity.

But there are benefits as well, many benefits that RAND sees coming from the new detail provided in ICD-10. And, as you will see, they far outweigh the costs.

– More accurate payments to hospitals for new procedures is believed to save $100 million to $1.2 billion.

– There are also benefits from fewer rejected claims, which may be $200 million to $2.5 billion.

– But wait there’s more… in the form of $100 million to $1 billion in fewer exaggerated claims.

– The identification of more cost-effective services and direction of care to specific populations would result in $100 million to $1.5 billion.

– There are also untold benefits that would come from better disease management and better directed preventive care.

In light of these enormous changes coming into effect many anesthesiologists are even more likely to benefit from outsourcing their billing to a medical billing company that specializes in providing anesthesia billing services.