ICD-9 vs ICD-10: What Are the Dangers for Your Home Health Agency

The last day you can legally use ICD-9 for your home health agency will be September 30, 2015, and beginning October 1, 2015, ICD-10 will become mandatory. The American Medical Association has estimated that the transition from ICD-9 to ICD-10 will cost small medical practices anywhere from $56,000 to $226,000. The consequences of not being ready for the switch, however, far outweigh the costs and re-training efforts that will be necessary to accomplish a smooth transition.

The Benefits of the New Code

Since the 9th revision of the World Health Organization’s international medical code was adopted in 1975, numerous advances and changes have occurred in the health care industry. It is not surprising that the 10th revision has many benefits as compared to 40 year old 9th revision. Three of the main benefits include:

1. Giving medical terminology used in the code a badly-needed update. The new medical language of the new code is far more modern, universal, and precise. It realizes the long-sought-after dream of a universal and consistent set of medical terms.
2. Adding much more data to the code to bring ICD-10 greater specificity.Rrevision 10 has some 68,000 individual diagnostic codes as compared to the 15,000 in revision 9, and uses seven digits instead of only five. The first three characters indicate diagnoses of diseases, the 4th stands for cause of disease, the 5th for body part affected, and the 6th for severity level. The seventh character is a place holder that allows greater detail to be added at a later date.
3. ICD-10 better organizes data according to the most modern classification system. The problem of old classifications (and terminology) has, up till now, been dealt with through “crosswalk” programs and complex conversion charts. Once the new code is implemented, there will be no need for conversions to identify the most up-to-date classification.

The Dangers of Not Being Ready

The updated code is coming, ready or not, and when it arrives, home health agencies had best be fully prepared. If you are not, you could suffer some rather dire consequences, among the following:

1. In extreme cases of unpreparedness, an organization could end up out of business. Once ICD-10 is required, no one will be able to bill without using the updated code.
2. An inability to consistently and correctly use ICD-10 could lead to penalties from Medicare and other government healthcare agencies. Problems with private insurance companies would also arise. Unless prepared for ICD-10, payments and claims will get denied or delayed.
3. By not preparing for the changes until the last minute, your staff will suffer which will effect their productivity rates for some time. The expenses of a sudden, emergency transition would put a deep dent in your budget and maximize the pain and pressure of learning a new system.

The Best Way to Prepare for ICD-10

There is a need for “transformational leaders” in the health care industry, leaders who will help create a paradigm shift toward a “staff-run” organization. When your staff is well-trained, highly motivated, and communicates appropriately with your medical coders, you have an organization that practically “runs itself.” Kenyon HomeCare Consulting can help you and your staff into that new paradigm. They offer excellent services that can get your entire staff ready for the transition from ICD-9 to 10. They can position your agency to move seamlessly from the old coding system to the new. You will gain the benefits of the new ICD-10 code and avoid the pitfalls of preparing too little or too late.