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By FELIZITAS DEVINE, RN, MS, MBA, CCM, a commissioner with the Commission for Case Manager Certification and a consultant with Healthcare Technology Management Services, and MINDY OWEN, RN, CRRN, CCM, who currently serves as an outside member on a CCMC committee and is also principal of Phoenix HealthCare Associates in Coral Springs, Fla.

Mention the newest International Classification of Diseases standards known as ICD-10--a major initiative to advance the electronic healthcare environment in the United States--and the reaction may very well be a blank stare. Although ICD-10 will result in a major and necessary overhaul in diagnosis and procedure codes used across the healthcare spectrum, few organizations have begun preparations.

Poor implementation or failure of a "crosswalk solution" to link the outdated ICD-9 with the greatly expanded ICD-10 may result in claims not being paid correctly--or potentially not being paid at all.

IT IS COMING

If organizations believe that the U.S. government will put off ICD-10 indefinitely, they are in for a rude awakening. The U.S. Department of Health and Human Services has lauded ICD-10, saying it will "fully support quality reporting, pay-for-performance, bio-surveillance and other critical activities."

Instead of ignoring ICD-10, insurers and healthcare organizations have a golden opportunity to prepare proactively for this next phase in the expansion of health information technology. This will require a transdisciplinary team to be assembled, with case managers playing key roles in educating and supporting staff and championing the ICD-10 implementation.

BENEFITS OF ICD-10

Admittedly, adoption of ICD-10 will be costly, particularly with the U.S. economy in recession, declining reimbursement for services, and increased cost burdens on hospitals and providers because of a rising number of uninsured and underinsured individuals.

Costs aside, healthcare stakeholders need to acknowledge the advantages of ICD-10 and its potential to increase efficiency, improve accuracy in reporting, and enhance data collection and outcomes analysis.

ICD-10 will also address several drawbacks that have become inherent in ICD-9, which is outdated and has limited ability to accommodate new procedures and diagnoses.

HHS has highlighted several benefits of ICD-10, including being congruent with value-based purchasing and Medicare's anti-fraud and abuse activities, and ensuring more accurate payments for new procedures, fewer rejected claims and improved complex chronic care management.

Expanded ICD-10 codes will enhance initiatives such as pay-for-performance and bio-surveillance (the automated monitoring of information that may help detect an emerging epidemic, whether naturally occurring or due to bioterrorism). In addition, the new code sets will allow the United States--which is one of the few developed countries not yet using ICD-10--to compare its data internationally to track the incidence and spread of disease and treatment outcomes.

"We are hopeful the new ICD-10 will address the shortcomings of the antiquated ICD-9 system as it is reported to offer more precision in coding and will have the ability to capture the use of newer procedures and technology," observed Sharon Coulter James, senior vice president-clinical services, at the University of North Carolina-Chapel Hill Hospitals. "Ultimately, we believe the use of the IC-10 will ensure more accurate billing and reduce the rework associated with rejected claims."

PREPARING: THE TEAM APPROACH

To prepare for ICD-10, organizations should use a team approach to cover three fundamental components:

1. Education

Devise an education plan that includes who needs to be educated on ICD-10 and how they will be instructed on its use, implications and overall compliance. Will the organization use online education, internal training or external classes? Determining the education plan in advance will help ensure timely training is provided and assist with asmooth implementation.

2. Information Technology

One of the most important steps is an assessment of the organization's current information-technology system and review of any planned upgrades to determine if it can support ICD-10.

What will it take to make the system compatible with ICD-10? What are the cost estimates for reengineering and implementation?

3. Operations

A team approach to ICD-10 implementation will mirror the strategies often taken when a healthcare organization prepares for accreditation, such as by the Joint Commission or the National Committee for Quality Assurance. Key members of the team should come from multiple departments and disciplines, including information technology and clinical resource management.

As the team is assembled, case managers will be especially important because they are more involved than ever in the management of healthcare dollars. As a result, case managers will not only have to be aware of ICD-10 and its impact on the system, but also will be central to the implementation of the rules of ICD-10, especially as they relate to transitions of care.

Further, the implementation team will look to case managers to inform and educate them as to the use ICD-10 code sets.

Despite numerous delays, ICD-10 is coming, and its impact on insurers, providers and other organizations across the healthcare spectrum will be significant. Rather than wait or hope for another delay in implementation, organizations need to get out in front of this development and use ICD-10 code sets to improve their efficiency in the new electronic healthcare environment.

April 15, 2009

Copyright 2009© LRP Publications