45 Ways to Say ‘Sprained Ankle’

November 20th, 2008 | Sources: Wall Street Journal

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Federal regulators will soon swap out an antiquated medical coding system for a new one that describes modern health practices more precisely. But the transition is going to hurt.

ICD-10 is the new system. It increases by a factor of 10 the number of codes specifying medical conditions and procedures in the US health system. The increased specificity should allow insurers to assign payments that accurately reflect the complexity and intensity of medical services.

As a bonus, the improved data should facilitate quality improvement projects and retrospective studies like the one revealing an adverse interaction between heartburn drugs and Plavix.

But many worry that the transition will be costly and error-prone. Minimally, thousands of providers will have to purchase new software and train nurses, physicians and coders. In fact, the Centers for Medicare and Medicaid Services, the agency that oversees the system, expects implementation costs to top $1.5 billion.

This estimate doesn’t include waste associated with an inevitable increase in coding errors as people get used to ICD-10. It also doesn’t account for a likely increase in billing fraud and payment delays.

There’s also concern that CMS’ proposed 3-year roll-out is too aggressive.

CMS’ recent track record on large implementation projects is not reassuring. In the last two months alone it has been accused of bungling the transition to a new claims processor and called out by a US Senator for poor service on its 1-800-Medicare help line.

ICD-10 implementation dwarfs those challenges.


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