You can take it to the bank that ICD-10 will ultimately be approved. ICD-9 is running out of codes to support the growing number of new high cost medical procedures.
But what about the overall healthcare provider financial cost-benefit?
To gain some insight on this, let's first look at superbills, which many providers use to allow for quick coding for reimbursement. The Blue Cross Blue Shield association just released a comparison of a current ICD-9 superbill to the equivalent using ICD-10. The new codes turn a 2 page superbill into a 9 page behemoth.
For example, an insect bite using ICD-9 is shown on the superbill as "919.4 Insect bite". (Thanks to an anonymous reader for the clarification that there are 18 ICD-9 insect bite codes of which 16 are specific to a particular body site and two are not).
Want to do the same thing using ICD-10? Here are your choices:
S00.06A Insect bite of scalp; Initial encounter
S00.06D Insect bite of scalp; Subsequent encounter
S00.269A Insect bite of unspecified eyelid and periocular area; Initial encounter
S00.269D Insect bite of unspecified eyelid and periocular area; Subsequent encounter
S00.36A Insect bite of nose; Initial encounter
S00.36D Insect bite of nose; Subsequent encounter
S00.469A Insect bite of unspecified ear; Initial encounter
S00.469D Insect bite of unspecified ear; Subsequent encounter
S00.561A Insect bite of lip; Initial encounter
S00.561D Insect bite of lip; Subsequent encounter
S00.562A Insect bite of oral cavity; Initial encounter
S00.562D Insect bite of oral cavity; Subsequent encounter
S10.16A Insect bite of throat; Initial encounter
S10.16D Insect bite of throat; Subsequent encounter
S10.86A Insect bite of other part of neck; Initial encounter
S10.86S Insect bite of other part of necks; subsequent encounter
S10.96A Insect bite of unspecified part of neck; Initial encounter
S10.96D Insect bite of unspecified part of neck; Subsequent encounter
S20.161A Insect bite of breast, right breast; Initial encounter
S20.161D Insect bite of breast, right breast; Subsequent encounter
S20.162A Insect bite of breast, left breast; Initial encounter
S20.162D Insect bite of breast, left breast; Subsequent encounter
S20.169A Insect bite of breast, unspecified breast; Initial encounter
S20.169D Insect bite of breast, unspecified breast; Subsequent encounter
S20.361A Insect bite of right front wall of thorax; Initial encounter
S20.361D Insect bite of right front wall of thorax; Subsequent encounter
S20.361S Insect bite of right front wall of thorax; Subsequent encounter
S20.362A Insect bite of left front wall of thorax; Initial encounter
S20.362D Insect bite of left front wall of thorax; Subsequent encounter
S20.369A Insect bite of unspecified front wall of thorax; Initial encounter
S20.369D Insect bite of unspecified front wall of thorax; Subsequent encounter
S20.461A Insect bite of right back wall of thorax; Initial encounter
S20.461D Insect bite of right back wall of thorax; Subsequent encounter
S20.462A Insect bite of left back wall of thorax; Initial encounter
S20.462D Insect bite of left back wall of thorax; Subsequent encounter
S20.469A Insect bite of unspecified back wall of thorax; Initial encounter
S20.469D Insect bite of unspecified back wall of thorax; Subsequent encounter
S20.96A Insect bite of unspecified parts of thorax; Initial encounter
S20.96D Insect bite of unspecified parts of thorax; Subsequent encounter
S30.860A Insect bite of lower back and pelvis; Initial encounter
S30.860D Insect bite of lower back and pelvis; Subsequent encounter
S30.861A Insect bite of abdominal wall; Initial encounter
S30.861D Insect bite of abdominal wall; Subsequent encounter
S30.862A Insect bite of penis; Initial encounter
S30.862D Insect bite of penis; Subsequent encounter
S30.863A Insect bite of scrotum and testes; Initial encounter
S30.863D Insect bite of scrotum and testes; Subsequent encounter
S30.864A Insect bite of vagina and vulva; Initial encounter
S30.864D Insect bite of vagina and vulva; Subsequent encounter
S30.865A Insect bite of unspecified external genital organs, male; Initial encounter
S30.865D Insect bite of unspecified external genital organs, male; Subsequent encounter
S30.866A Insect bite of unspecified external genital organs, female; Initial encounter
S30.866D Insect bite of unspecified external genital organs, female; Subsequent encounter
S30.867A Insect bite of anus; Initial encounter
S30.867D Insect bite of anus; Subsequent encounter
S40.269A Insect bite of unspecified shoulder; Initial encounter
S40.269D Insect bite of unspecified shoulder; Subsequent encounter
S40.869A Insect bite of unspecified upper arm; Initial encounter
S40.869D Insect bite of unspecified upper arm; Subsequent encounter
S50.369A Insect bite of unspecified elbow; Initial encounter
S50.369D Insect bite of unspecified elbow; Subsequent encounter
S50.869A Insect bite of unspecified forearm; Initial encounter
S50.869D Insect bite of unspecified forearm; Subsequent encounter
S60.369A Insect bite of unspecified thumb; Initial encounter
S60.369D Insect bite of unspecified thumb; Subsequent encounter
S60.468A Insect bite of other finger; Initial encounter
S60.468D Insect bite of other finger; Subsequent encounter
S60.469A Insect bite of unspecified finger; Initial encounter
S60.469D Insect bite of unspecified finger; Subsequent encounter
S60.569A Insect bite of unspecified hand; Initial encounter
S60.569D Insect bite of unspecified hand; Subsequent encounter
S60.869A Insect bite of unspecified wrist; Initial encounter
S60.869D Insect bite of unspecified wrist; Subsequent encounter
S70.269A Insect bite, unspecified hip; Initial encounter
S70.269D Insect bite, unspecified hip; Subsequent encounter
S70.369A Insect bite, unspecified thigh; Initial encounter
S70.369D Insect bite, unspecified thigh; Subsequent encounter
S80.269A Insect bite, unspecified knee; Initial encounter
S80.269D Insect bite, unspecified knee; Subsequent encounter
S90.463A Insect bite, unspecified great toe; Initial encounter
S90.463D Insect bite, unspecified great toe; Subsequent encounter
S90.466A Insect bite, unspecified lesser toe(s); Initial encounter
S90.466D Insect bite, unspecified lesser toe(s); Subsequent encounter
S90.569A Insect bite, unspecified ankle; Initial encounter
S90.569D Insect bite, unspecified ankle; Subsequent encounter
S90.869A Insect bite, unspecified foot; Initial encounter
S90.869D Insect bite, unspecified foot; Subsequent encounter
And that is just for insect bites.
Providers will clearly need to be prepared with education, software and process improvements to deal with ICD-10, in addition to complex transaction integrations and implementations. And transitional reimbursement challenges such as retroactive adjustments using different code sets will be entertaining, to say the least.
A recent study assessed the cost impact of the proposed ICD-10 rule on providers. For a typical 10 provider practice, the cost is $285,195. And for a large practice? $2.7 million.
CMS listed 6 reasons for the move to ICD-10:
- More accurate payments for new procedures
- Fewer rejected claims
- Fewer improper claims
- Better understanding of new procedures
- Improved disease management
- Better understanding of health conditions and health care outcomes
- Harmonization of disease monitoring and reporting world-wide
In conclusion, the effect of these limited benefits and high costs could be more painful to providers than an "S30.867D".
