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June 2014

Chicken Little Meets ICD-10
By Judy Sturgeon, CCS, CCDS
For The Record
Vol. 26 No. 6 P. 8

To anyone who believed the Centers for Medicare & Medicaid Services’ (CMS) repeated assurances that there would be no further delays in the ICD-10 implementation deadline, it’s time to find a new religion. In an unanticipated sneak attack, the CMS’ plans were set aside when the House of Representatives and then the Senate passed HR 4302, Protecting Access to the Medicare Act of 2014, on March 31. Appropriately enough, President Obama signed the legislation into law on April Fools’ Day.

The bill’s primary purpose was to create one more patch to the sustainable growth rate formula that repeatedly threatens to decimate Medicare’s physician payments. It left many in the HIM profession wondering exactly how the long-anticipated but never-realized transition from ICD-9 to ICD-10 fit into the equation. The answer to that question—despite no short supply of theories—may never be answered.

Where Do We Go From Here?
As of press time, it was all but official that October 1, 2015, would be the new ICD-10 implementation deadline. The bill states that “the Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standards for code sets.”

Even though the federal government has announced an updated true, final, absolute date, who can believe it? With this uncertainty creating great concern in the coding community, what are the health care professionals most affected by the change in code sets supposed to do now? Keep changing plans year after year? Keep spending money to retool software and reeducate staff time and again?

Veteran coders have been threatening to hang up their credentials rather than discard years of ICD-9 skill and start all over with no more knowledge of ICD-10 than novice coders. For those holding out until the last minute to retire, their clock is going to need at least another year’s worth of batteries. Those who already have called it a career may want to consider their retirement fund’s status and inquire whether their old position is still up for grabs.

Unfortunately, that’s perhaps the simplest of scenarios. How many coding professionals have already changed careers and lost the skills necessary for an easy transition back to being a full-time ICD-9 coder?

There are coders who relied on the “absolute” transition date, who studied and achieved—at great expense—certification as an ICD-10 trainer. The career potential for these elite coding trainers was purported to be virtually unlimited. Now, if they haven’t already abandoned the new credential in disgust, they’re required to recertify at further expense on an annual basis. In addition, there’s even less assurance that they haven’t wasted time and large amounts of cash on what looks more like a mirage rather than a promising new career.

While job opportunities for trained ICD-10 coders have soared in all areas of the hospital, coders with only ICD-9 skills have seen their résumés moved to the bottom of the hiring stack. Do hospitals and contract agencies need to swap out their talent again? Having already spent money on ICD-10 training and suffered through productivity losses, many employers now must consider repeating the entire scenario, only this time the effort will be directed at ICD-9 training for new coders and physicians.

The viability of professional positions specifically created to support the ICD-10 transition hangs in the balance. Hospitals, physicians, software developers, and contractors already spent a sizable chunk of change on preparations only to see the finish line and its associated payday disappear. After this latest setback, how many will be willing to continue supporting ICD-10 related jobs?

Far-Reaching Effects
Consider the delay’s impact on academic institutions and credentialing agencies. For students to be able to learn coding skills that are viable both now and in the future, schools must plan a curriculum well in advance of the next semester. Educational and professional credentialing tests must accurately reflect the skills coders will be using most frequently in the current work environment and beyond. Now, however, any exams that have already dropped ICD-9 in favor of ICD-10 must return to their original formats—or do they? With no clue as to when—or if—ICD-10 will become a reality, is it wise to dedicate any more efforts to its cause?

Agencies that validate a school’s academic credibility also must have significant lead time in order to evaluate both the instructional content and the students’ academic competence. Without a fixed plan for transitioning to a new code set and no expectation that the latest date will be reliable, how will any school be able to properly focus its curriculum? The reality is that educators will have to default to more of a shotgun approach, aiming a lot of training at all possible targets in hopes that some of it will hit a valid objective. In all likelihood, this strategy will cause students and trainers to lose even more money and time.

To help mitigate the concerns of students who focused their schooling on ICD-10, AHIMA has posted a free webinar, “ICD-9-CM: Back to the Basics,” to help them prepare to sit for certification exams in ICD-9.

The Best-Laid Plans
Have promising coding students looking to start with a clean slate postponed the beginning of their studies until the final verdict on ICD-10 is delivered? Have health care organizations hired recent graduates with ICD-10 credentials based solely on their mastery of the new codes? How’s that arrangement going to work out?

Imagine how much money hospitals, payers, and physicians have spent on expensive software contracts and products in hopes of minimizing ICD-10’s financial and data reporting impact. Also consider the number of vendors that shifted or expanded their business model to meet those needs.

How long can the industry shout, “The sky is falling! The sky is falling!” until it falls on deaf ears? The patience of hospital coding staffs is justifiably wearing thin, while the C-suite questions its ICD-10 investment strategy.

Is ICD-10 this century’s version of the United States’ ill-fated attempt to convert to the metric system? The only significant remnant of that debacle is the 2-liter soda bottle. Should the ICD-10 transition follow a similar path and the constant delays ultimately become abandonment, the one lingering souvenir from its bizarre history may be this tidy code: K6289, Pain in the rectum.

— Judy Sturgeon, CCS, CCDS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 22 years.