HIMSS looks at ICD-10 from FY16 into FY17

ICD-10 finally took effect on October 1, 2015.  Fortunately, as a result of much hard work on the part of providers, payers, consultants, IT departments and vendors, the transition went relatively smoothly. 

The members of the HIMSS ICD-10 Task Force have been valuable contributors to the ICD-10 education effort. Numerous articles have been written for Business Edge, presentations have been given by members of our ICD-10 Speaker’s Bureau, and content has been continually added to our ICD-10 Playbook

Although there have been scattered reports of increased denials or delays in payment, overall the industry has fared well with the transition. In some cases, hospitals have seen increases in DRG reimbursement due to the improved specificity afforded by ICD-10 codes.

Two challenges loom on the horizon.  The first is the updated code set, expected to be out later this year.  However, this is similar to the yearly updates of ICD-9 codes and can be approached in the same way.

The other challenge is the expiring Medicare “grace period” for ICD-10 coding specificity. For the first year of ICD-10 implementation, Medicare agreed not to deny reimbursement based solely on the ICD code specificity, as long as the ICD-10 code was a valid code from the proper ICD-10 code “family”, in other words, as long as the first 3 characters of the ICD-10 code were correct. This grace period is set to expire at the end of September. Providers should be preparing for this by fine-tuning their diagnosis coding to the highest appropriate specificity.

HIMSS will continue to monitor industry progress with the operationalizing of ICD-10, paying particular attention to any disruptions created by the expiration of the CMS grace period, and respond as appropriate with tools and resources to mitigate such disruptions.  Assuming all continues to go well, however, we anticipate sun-setting the ICD-10 Task Force and the ICD-10 PlayBook effective December 1, 2016.  We encourage you to continue accessing the PlayBook for up-to-the-minute tools and resources designed to make your move to ICD-10 as beneficial as possible.  An update on the status of the task force and the ICD-10 PlayBook will be provided in November’s Business Edge.

About the author: Dr. Sunday is board-certified in Family Medicine. She graduated from the State University of New York at Buffalo (UB) School of Medicine and completed her Family Medicine Residency at St. Vincent's Hospital in Erie, PA, where she was chief resident in her third year. She also serves as an adjunct faculty member in the HIT program at Canisius College and is a consultant for HEALTHeLINK™. Bonnie has served as Chair of the HIMSS ICD-10 Task Force in FY16 and will continue in FY17.