Lessons learned from ICD-9 implementation

When healthcare transitioned to ICD-9 on Oct. 1, 1984, there was still great confusion 18 months later on how to submit the codes. There was great deal of frustration both on the provider side as well as the health plan side. There was also a huge lack of training to prepare the doctors for the transition to ICD-9. As a result, for almost a year, there were large drops in revenue.

I am seeing things now, for ICD-10, that I witnessed back then for ICD-9. A great deal of people have not even started their processes. I think the last figures I saw showed less than a third of the medical population has begun processes to implement ICD-10, which includes the 5010 Readiness Evaluation, the training processes, understanding their vendors’ readiness, etc.

I had a conversation with a client from a health system with 27 hospitals and about 10,000 doctors. He said that the most frustrating part of the transition to ICD-10 for him are the responses from their vendor community. As you can imagine, there are a tremendous number of systems within a large integrated delivery system that touch ICD-10.

Their primary vendors seem to be prepared. But a lot of the secondary vendors - in the lab area, the radiology area, a lot of the ancillary systems - still are not advertising or articulating where they are in the process. Until these vendors respond, these systems are going to have to be more of a retrospective coding function versus prospective coding. Some of these systems won't be able to assign a code, because they don’t know how they are going to operate as it relates to the total process. So that’s a very frustrating factor for a lot of CIOs.

I used this particular client as a bellwether, because they were one of the first to adopt ICD-9 back in the 1980s, and they did it very well. It makes me think we are going to have the similar problems now with ICD-10.

The other issue that has not been dealt with is the training issue. What is it going to take to train healthcare providers for this new complex system? That’s going to be a tremendous undertaking. One of the things that people can do if they have a claims editing tool in place within their organization (on the inpatient side and the ambulatory side), is run their claims through in a profile mode (e.g., don’t stop the claims if there is an error) to be able to see where the coding errors are, and use the opportunities to train providers.

Overall, the lack of preparation is similar to what it was in Y2K as well as ICD-9. We are going to see some reimbursement reduction as this transitions, as we did in ICD-9. What the extent will be, I don’t know, but I am going to assume it's going to hit some pocketbooks very hard.

The number one priority of course is to finish the 5010 evaluation. It’s a requirement, and critically important. Then, you must assess your ICD-10 processes – it is the most important piece. It is not a lengthy process, but it is one where money invested is going to pay dividends. Also, be prepared for the unexpected. As with any transition to a new system that affects reimbursement, I think healthcare organizations need to be financially ready for a hit to the revenue cycle initially, and have a lot of backup plans. They should anticipate the reimbursement lag during the transition, and have enough reserves ready to make it whole. Within that is testing, testing, and testing - you can't do enough testing in this process.