Managed Care - December 2008 - (Page 13)

“Under the current ICD-9-CM volume one and two, a five-position numeric — 733.01 — would become, under ICD-10-CM, M80.011A,” says Daley. “It doesn’t correlate at all.” Or take laparoscopic appendectomy. Under ICD-9, that’s 47.01. Under ICD-10-PCS, four positions with a decimal point in the middle become seven positions, no decimal point: ODTJ4ZZ. It is all about nuance. For instance, there’s only one ICD-9 code for angioplasty: 39:50. Under ICD-10, there will be about 1,170. “With ICD-9, we can’t measure which ones work better than the other ones. We pay for them all the same,” says CMS’s Trudel. “If we wanted to look at the quality of a variety of stents, for instance, we wouldn’t be able to do it, because it’s all about one code.” CMS’s notice of proposed rulemaking (NPRM) published in the Federal Register Aug. 22 “Aetna will comply with all requirements to adopt the ICD-10 notes that “ICD–9–CM has a single diagnosis codes,” although the deadlines imposed by the government will code for fracture of the wrist. If a patient is treated indeed be challenging, says James Cross, MD, Aetna’s head of for two successive wrist fractures, the ICD–9– national medical policy and operations. CM code does not provide enough detail to determine if the second fracture is a repeat fracture of the same wrist, a fracture of the other wrist, intional burden on hospitals (and to some extent correct billing for delayed healing, or non-union or payers) because they will be used to describe inmal-union of the original fracture.” patient procedures. There are approximately 13,000 Says Sidorov: “Managed care insurers are not ICD-9-CM codes; ICD-10-CM will have 68,000. worried about the prospect that having more codes There are approximately 3,000 ICD-9-PCS codes; equals covering more stuff. It’s the same stuff in far ICD-10-PCS will have 87,000. All told, ICD-10 greater detail, which will entail considerable remeans an expansion of the coding system from the design on their internal workflows. Will this re17,000 codes in ICD-9 to 155,000. design translate into meaningfully greater quality Jim Daley, a former HIPAA program director, at lower cost? At this time they’re unable to answer was one of the driving forces for the first white that simple question.” paper on this subject about eight years ago for WEDI Says Daley: “Theoretically the coding system — the Workgroup for Electronic Data Interchange shouldn’t change what is covered or not covered. — a national organization that advises the governHowever, with the increased granularity and rement on technology standards for health care. categorization of some codes, there may be some “Medical directors have to address all of these confusion during the transition. Also, the increased codes,” says Daley, currently the director of risk and granularity may provide better delineation of what compliance in the information systems department is or isn’t covered.” at Blue Cross Blue Shield of South Carolina. The fundamental challenge, says an IT expert at The most daunting aspect of ICD-10 isn’t simHarvard Pilgrim Health Care, is that all of the softply its size. It will also not look at all like the 27-yearware and processing systems in place require exold ICD-9. Under ICD-10 CM, the number of chartensive modifications or in many cases wholesale acters used to express a specific disease/procedure replacement to accommodate the increased numgoes from xxx.yy numeric to xxx.yyyy alphaber of characters, the use of alpha characters, and numeric. the geometric increase in processing logical perDaley sites senile osteoporosis as an example. DECEMBER 2008 / MANAGED CARE 13

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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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