ICD-10 and What the Ebola Virus Means for Healthcare Reimbursement

Public health officials are learning more every day about the procedures required to care for Ebola patients. But one thing that the Ebola crisis has revealed is that the health care system lacks the classification codes to track the disease and ultimately, to reimburse for care of patients who have the disease.

what the ebola virus means for healthcare reimbursementICD-9 has no specific code for Ebola. Under the classification system, the hemorrhagic fever would currently fall under 078.89 – the code for “other specified diseases due to viruses.” That means Ebola shares a code with many other viruses that have not yet been assigned a specific code. The next iteration of the classification system, ICD-10, gives Ebola the code A98.4. But the U.S. Congress in the spring delayed implementation of the new classification system. The fact that the United States still uses ICD-9 will make it more more difficult to share information about the disease and its movement with other countries, HIT Consultant reported. All of the world’s industrialized nations use ICD-10 and use the codes in the newer system to report health information to the World Health Organization.

Besides disease tracking, health officials are starting to learn what the Ebola virus means for healthcare reimbursement. The classification codes are also important for reimbursing the cost of care. When health claims are submitted to payers, the claim must include a code to indicate a particular disease or procedure. If any more Ebola cases arise in the United States, ICD-9 allows no way for a health care provider to submit a claim specifically for Ebola. Thomas Eric Duncan, the Liberian man who was treated at Texas Health Presbyterian Hospital in Dallas, had health care costs estimated at $1,000 an hour, Bloomberg News reported. That cost takes into account not only the care provided to Duncan, but also the expense of isolation procedures for an Ebola patient. The Texas hospital is not expected to recover any of the costs associated with the care of Duncan, who was uninsured.

The Texas hospital has offered to pay the health care costs of Nina Pham, one of the nurses who treated Duncan and was later diagnosed with Ebola, while she was in the hospital’s care. Pham was recently declared Ebola free after being treated at the the National Institutes of Health; that bill will likely be picked up by the federal government.

ICD-10 offers a way to submit health care claims for Ebola and also file for reimbursement for treating patients with the disease. But its implementation did not come in time for Ebola’s arrival in the United States. Much is still being learned about the procedures hospitals need to use to care for Ebola patients and it’s unclear whether new codes will be needed. But what is now clear is that the health system has a classification code for Ebola but for now, it has no way to use it. To learn more, contact us.

ICD-10 Delay: What It Means to Healthcare Educators and Students

For a second time, legislation was passed to delay the implementation of ICD-10 code sets used by healthcare providers until October 1, 2015. This decision will cause a one-year setback from an original adoption date on October 1, 2014. The announcement was in addition to a previous delay that occurred in August 2012.

Many organizations have been diligently working to train their coders and care providers for some time now. With the delay, clinicians and coders worry about losing their knowledge.

The American Health Information Management Association (AHIMA) responded to the signing of H.R. 4302 with a statement quoting CMS as saying that this delay could potentially cost the healthcare industry 6.6 billion dollars. Medical businesses have been working to educate both their coding and IT staff for months. Now they may have to retrain their staff in 2015, assuming there are no further delays.

ICD-10 Delay: What It Means to Healthcare Educators
ICD 10 healthcare educatorsHealthcare educators and students have been negatively affected. The ICD-10 delay has significantly impacted healthcare educators. Instructors are now required to adjust their teaching timelines and curriculum to cover both ICD-9 and ICD-10 for students. Because students need to learn the current system, as well as the future system, educators will have to teach both systems concurrently.

The delay means students will need to learn ICD-9 coding for an additional year. The delay also hurts students who are ready to enter their profession this year. Learning two different coding systems at the same time is extremely challenging for students. Those students who are at the end of their programs, and may have delayed coding courses so they would only need to learn the ICD-10, will now be required to learn both systems.

Students who learned ICD-10 coding, and who have recently graduated, won’t have the opportunity to use their new skills. It’s quite possible that these students will forget some of their ICD-10 coding skills if they are only using ICD-9 codes. Students may need to take additional classes or refresher courses and study the new codes a second time.

The delay also affects educators’ budgets. In anticipation for the ICD-10 transition, educators created budgets that would drop the resources needed to teach ICD-9 courses. Now, those courses must continue to be taught, and instructors’ salaries, classroom materials, and other necessary resources must come out of the existing budget.

Delaying the implementation of ICD-10 coding may help physicians and healthcare systems that were not prepared for the transition, but the setback has significantly hurt current students and put a larger burden on healthcare educators’ time and budgets.

For more information about making the transition to ICD-10, contact us today.

ICD-10: Ready or Not, Here It Comes

ICD-10 avidity medical designThe only thing constant in life is change. This saying has always been true.

One of the biggest changes that will occur in 2014 is the transition from ICD-9 to ICD-10 on October 1, 2014. Results of a recent Medical Group Management Association (MGMA) survey show that less than 10 percent of physician practices are ready for ICD-10. MGMA president and CEO, Susan L. Turney, made it very clear that immediate action is required to prepare for the October deadline:

“The critical coordination that must take place between practices and their software vendor, clearinghouse and health plan partners is simply not happening at the pace required for a seamless implementation.”

In the same MGMA survey, over 85 percent of physician practices were concerned or very concerned about expected changes in clinical documentation, loss of clinician productivity, and loss of coding staff productivity after the transition from ICD-9 to ICD-10.

It is time for the majority of healthcare providers and organizations to begin preparing for the upcoming transition to ICD-10. The shift to ICD-10 means that physicians, coders, and other HIM professionals must be up to speed on the changes to diagnosis code assignment and ready to assign ICD-10 codes accurately, completely, and efficiently by October 1, 2014.

I hear and I forget

I see and I remember

I do and I understand

Avidity Medical Design will help you understand the changes that will occur with ICD-10. We will also develop customized ICD-10 curriculum to prepare your staff for ICD-10 coding prior to the scheduled implementation on October 1, 2014.