Challenges

The transition to ICD-10 will affect every segment of the US healthcare industry. From providers to payers, the transition includes the replacement of existing systems to support ICD-10, retraining the entire medical support work force, and incorporating strategies to avoid errors and insure success.

Coding Professionals: The new classification system does retain the traditional format and many of the same characteristics and conventions and thus, should not be too difficult for experienced coders to achieve coding proficiency. An additional problem that could be encountered is a shortage of credentialed, professional coders. Currently, there is a shortage of coders skilled in both ICD-9-CM and CPT coding, and some coders may opt to retire before learning an entirely new system thus exacerbating the problem. Labor statistics predict a shortage of trained coders in the next several years.

Payers: Payers need to modify or upgrade all systems that currently use the ICD-9 set, and provide training on ICD-10 coding classification to all members. Due to dual coding systems, the work load will increase considerably which could lead to a delay in reimbursement and an increase in the backlog of claims. Additional staff members will be required for claims adjudication, claims auditing and fraud detection.

Providers: Although providers must also implement the same ICD-10 code sets as payers, the challenges faced by providers are much different than those faced by payers. For providers, this compliance effort introduces ICD-10 into the clinical process. With the increased specificity in ICD-10-CM, this issue will continue to be an essential element in the collection of good statistical data as well as the key to appropriate reimbursement. Among the primary challenges, are training needs, vendors, clearing house and health plan contracts, billing form revision or replacement and data requirements will need be to reviewed and amended.