Managed Care - December 2008 - (Page 1)

EDITOR’S MEMO Care Editor M A N A G E D ICD-10 Code Change Is Long Overdue By John Marcille hange isn’t always progress, but in this case, it surely is. The move to ICD-10’s vastly expanded set of disease and procedure codes is necessary because of the many changes in medicine and surgery that have taken place over the decades since the last true overhaul of the ICD code set over 60 years ago! Yes, it’s about time. Our managing editor, Frank Diamond, in our article that begins on page 12, examines many of the difficulties that lie ahead, starting with one that should be resolved very soon: whether the Centers for Medicare and Medicaid Services will stick to the Oct. 1, 2011 implementation date. Frank discusses the challenges that health plans and payers will face in trying to implement the new ICD-10 codes. It’s a complicated process that will alter the most basic functions health plans perform, says Jim Daley, director of risk and compliance in the information systems department at Blue Cross & Blue Shield of South Carolina. He is a nationally known expert on the subject. “Health plans look at certain conditions and say they should be treated in a certain way, or this is appropriate or not appropriate for a given condition,” he says. “Those decisions are based, obviously, on the medical condition, but also on the wording and the code associated with it.” There have been minor changes over the years, but even so, it has been 27 years since the last upgrade to the International Statistical Classification of Diseases and Related Health Problems, and medicine has evolved far beyond ICD-9’s capacity to describe it. Says Karen Trudel, the deputy director of the Office of E-Health Standards and Services at CMS: “Most parts of the health care industry agree that this needs to be done and that the real discussion is what’s the timing for it and that it’s a major undertaking.” MC JOHN MARCILLE Managing Editor FRANK DIAMOND Associate Editor C TONY BERBERABE Consulting Editor MICHAEL DALZELL Senior Contributing Editor MARGARETANN CROSS Contributing Editors LOLA BUTCHER JOHN CARROLL MAUREEN GLABMAN MARTIN SIPKOFF Design Director PHILIP DENLINGER President and Group Publisher TIMOTHY P. SEARCH, RPH President and Group Publisher TIMOTHY J. STEZZI Eastern Sales Manager SCOTT MACDONALD Senior Account Manager KENNETH D. WATKINS, III Director of Production Services CONTACT E-MAIL ADDRESSES: Editors: Editors_mail@ManagedCareMag.com Circulation: Managedcare@icnfull.com Advertising: Advertising_info@ManagedCareMag.com Reprints: Reprints_request@ManagedCareMag.com WANETA PEART Circulation Manager JACQUELYN OTT Clinical judgment must guide each clinician in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this publication may reflect the professional literature or other clinical sources, or may reflect the clinical experience of the authors, and might not be the same as what is on the approved package insert. Please consult the complete prescribing information for any products mentioned in this publication. MediMedia USA Inc. assumes no liability for the information published herein. MANAGED CARE (ISSN 1062-3388) is published monthly by MediMedia USA, Inc. at 780 Township Line Road, Yardley, PA 19067. This is Volume 17, Issue 12. Phone: (267) 685-2788; fax (267) 685-2966. Send letters to the editor to Frank Diamond, MANAGED CARE, 780 Township Line Road, Yardley, PA 19067. Letters may be edited for length and clarity. Copyright 2008 by MediMedia USA, Inc. All rights reserved under the United States, International, and Pan-American copyright conventions. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, electronic, or otherwise, without the prior written permission of MediMedia USA Inc. The copyright law of the United States governs the making of photocopies or other reproductions of copyrighted material. Subscriptions for individuals or institutions in the U.S.A. are $100 per year, $10 per single copy; elsewhere, $120 per year, $22 per single copy. Inquiries about paid subscriptions: Lisa Gardineer, telephone (267) 685-2789; e-mail: lgardineer@medimedia.com-. Postmaster: Send address changes to MANAGED CARE, PO Box 2019, Langhorne, PA 19067. Periodicals postage paid at Morrisville, PA, and at additional mailing offices. Major articles are reviewed by appropriate members of the editorial advisory board and/or other qualified experts. Opinions are those of the authors and not necessarily those of the institutions that employ the authors, nor of the publisher, editor, or editorial advisory board of MANAGED CARE. DECEMBER 2008 / MANAGED CARE 1

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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