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FORBES: Medicare’s 140,000 New Diagnosis Codes Doctors Hate

By Bruce Japsen

5/04/2013 – The health care industry is “not progressing at a suitable pace” to be ready for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the insurance billing process, a new analysis shows.

Though the conversion to 140,000 new codes that medical-care providers will use in order to bill government and private insurers doesn’t occur until Oct. 1, 2014, last month’s analysis by the Workgroup for Electronic Data Interchange, or WEDI, is important because it will take months for hospitals and doctors to get their systems in place and test.

WEDI is an industry group that closely follows the change in International Classification of Diseases Codes, or conversion to 140,000 codes under the new ICD-10 system from 17,000 in the current ICD-9 coding system.

The conversion is being required by the Centers for Medicare & Medicaid Services to provide more specificity to the existing coding system. The current ICD-9 codes have limited information about medical conditions and hospital procedures while the new ICD-10 code “sets provide flexibility to accommodate future health care needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers,” Marilyn Tavenner, Acting Administrator of the Centers for Medicare and Medicaid Service wrote to the American Medical Association, which has urged a delay in implementing the new codes.

But the health care industry is worried it will not be ready, saying they still have to train their office staffs, buy the right computer systems and grapple with the mountain of administrative and related changes necessary that increases the number of diagnostic codes to about 69,000 from nearly 14,000 while the number of inpatient procedure codes rises to about 87,000 from about 3,000.

The WEDI analysis could indicate problems are ahead.

“Over two-fifths of provider respondents indicated they did not know when they would complete their impact assessment, business changes, and begin external testing,” WEDI chairman Jim Daley wrote in a letter last month to U.S. Secretary of Health and Human Services Kathleen Sebelius. “This is essentially the same as in the 2012 survey, and indicates that many providers have not made significant progress toward ICD-10 implementation.”

Members of Congress such as U.S. Rep. Ted Poe, a Republican of Texas, are beginning to weigh in on behalf of medical-care providers that he said are on the verge of being buried by what he called a government intrusion with “more regulations” that only “makes things more complicated.”

In January, more than 40 doctors groups including the American Medical Association, American Academy of Family Physicians and Medical Group Management Association wrote a letter to the Obama administration to stop the new coding system, saying it would cause additional financial pressures on doctor practices, particularly smaller physician offices already getting hit hard by the costs of implementing electronic health records.

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