ICD-10: What you should know

“Some people say that this is the biggest change to our health-care system since Medicare”, said Linda Zinkovich, chief operating officer of Orlando Health Physician Associates. If they don’t use the right codes, down to the decimal, they may not be paid sufficiently – or at all. Her group warns ICD-10 forces doctors to focus on codes rather than care, while at the same time intruding on patient privacy. Among the targets: W61.33 (pecked by a chicken), Y08.01 (assault by hockey stick) and R46.1 (bizarre personal appearance). “They have a coding backlog”. The new system increases diagnostic identification from about 14,000 codes to 70,000. ICD-10 has almost five times more codes than were used in ICD-9.

The reason for the change? And a few of the information was wrong or obsolete. But transitioning to the updated set of codes has its challenges. Did you break your shinbone?

There’s one code for if you get crushed by an alligator. Providers will be paid, won’t be audited, and won’t face penalties if they make unintentional errors on specific codes.

ICD-10 is here for home health agencies in most states, whether they are ready or not. In ICD-10, there will be 18 codes, which include which ear, if there’s drainage, if there’s damage to the ear drum and more, Zinkovich said. California’s upgrade is expected to be completed by 2017. It’s about keeping up with the complexification of health care.

“We’re about as prepared as any region can be”, senior manager Larry Sharfstein, who has been leading the process.

The World Health Organization sets the global Classification of Diseases, used by doctors and hospitals to categorizes diseases and procedures, and to bill insurance companies for payment.

Descriptions for diseases, symptoms, abnormal findings, patient complaints, causes of injury or illnesses and even social circumstances are included in the new diagnostic list.

What’s more, like Campbell, they said that communication should be constant. Benefits experts told Forbes that health plan enrollees could see a delay in authorization for certain tests and procedures if physicians don’t correctly code the services and that insurance claims could be denied.

In the small town of Paradise, Calif., 85 miles north of Sacramento, Thorp said his 18-person medical group is hoping for the best. The company will be issuing reports on the performance of the new system and looking for trouble spots, he said.

Most coders will still be inputting a backlog of ICD-9 claims for up to two weeks, according to Nate Seaman, associate vice president of product management for MedeAnalytics.

For one, “we don’t know what’s going to happen when the claims are submitted”, said Zinkovich, who will be in her office bright and early awaiting the arrival of the first claim.