Nation’s Medical Coding System Makes Big Switch On Thursday

If you’re attacked by a turkey today, Arkansas medical providers will submit claims under one set of codes. If it happens tomorrow, they’ll use a different set – if they’re ready.

The federal government is requiring all medical providers to switch from the ICD-9 medical coding system to ICD-10 on Oct. 1. ICD-9, which has been in use in the United States since 1979, categorizes all medical ailments and procedures into 14,000 codes. ICD-10, which was endorsed by the World Health Organization (WHO) in 1990, categorizes those procedures into 69,000 far more specific codes that detail the exact ailment (for example, which arm was broken) and its cause.

“ICD” stands for “International Classification of Diseases.” Its earliest version was adopted by WHO in 1893.

ICD-10’s specificity presents a more accurate picture of society’s health care challenges and expenses. However, that specificity can reach comic extremes. For example, it features nine separate codes for turkey-related injuries, including one if the patient was struck by a turkey and another if the patient was pecked.

An American Medical Association study found that, between training costs and software purchases, a small practice will spend between $56,639 and $226,105 making the switch, with larger practices spending up to $8 million.

David Wroten, executive vice president of the Arkansas Medical Society, said in June that of the 95 clinics that had responded to a survey, only 16% said they were ready to implement ICD-10, and almost 30% did not believe they would be ready in October. About 60% said they had provided training for coding staff, while about 40% had trained clinical staff.

Scott Smith, communications director, said Tuesday that the AMS didn’t have updated numbers.

“Certainly there will be some physicians that it will be a challenge to make it through this, but we don’t necessarily expect it to be a sky is falling situation,” he said. He later said, “There is concern out there and a question as to the preparedness, but we’ll get there.”

The federal Centers for Medicare and Medicaid Services recently said it won’t deny wrongly coded Medicare claims for a year as long as the claims are in the right family of codes. Providers will be paid, won’t be audited, and won’t face penalties if they make unintentional errors on specific codes.

The Arkansas Department of Human Services will not have a grace period for Medicaid patients, but it will allow unprepared providers to submit paper claims. Spokesperson Amy Webb said that could result in delays.

“If, say, 5,000 people submit paper claims in one week, well, it’s going to take us a while to process that,” she said. “So it could be a few weeks before they get paid.”

Medicare is a federally administered program serving senior citizens. Medicaid is a partnership between the federal government and the states serving lower income residents, the disabled and others. It is mostly managed by states.

DHS has been working on the transition since February 2012, when it launched a website and began hosting educational sessions for the state’s 38,000 Medicaid providers. This year, it underwent a 90-day testing period. In July, it hosted town hall meetings in 16 states that attracted 762 participants. It also created a commend center to address problems as they arise.

Webb said that the testing “found some minor issues,” but overall, “We feel comfortable that we’re ready to take the new codes. What we don’t know yet is how many of our providers are ready.”

She said that large providers like hospitals and multi-physician clinics probably are prepared, but smaller providers and those in rural areas may not be.

That level of preparation won’t be clear until claims are submitted over the coming days. All medical events that occur Wednesday will be coded in ICD-9, even if the claims are made starting on Thursday.