Medical Providers Face Huge Shift To New Coding System

Sept. 28--TAMPA -- Medical professionals in the Tampa area expect some headaches when the government launches its new medical coding system on Thursday but say the long-term benefits should be worth the pain.

The new coding rules, the 10th edition of the International Classification of Diseases, have been years in the making and will replace a coding system that has been in place for 30 years. The Centers for Medicare & Medicaid Services says expanding the coding index from about 14,000 to nearly 70,000 codes will lead to more accurate patient diagnoses while ensuring insurance companies correctly reimburse health care providers for services.

By being more specific, the new system will help health care officials track quality of care while enabling doctors to identify developing outbreaks and tailor treatments for the common cold or rarer maladies such as tick-borne relapsing fever, the Centers for Medicare & Medicaid Services says.

That doesn't mean the new system hasn't been a huge amount of work for doctors' offices, hospitals, insurers and other medical providers.

Tampa General Hospital has been preparing for the new system since 2010, when it originally was set to launch, said Anthony Escobio, the hospital's director of patient financial services.

"That preparation includes education of our staff and our physicians," Escobio said. "It's been a long, difficult process to prepare for it."

Not surprisingly, many injuries and medical conditions have numerous classifications under the new system. Atherosclerosis, for example, which is a condition in which plaque builds up in a patient's arteries, now is broken down into more than two dozen classifications.

Escobio said the new coding system has required major software upgrades at Tampa General and hospitals across the country. If the new coding system does not comply with a hospital's software, he said, it could delay payments from commercial insurance companies and governmental health care insurers such as Medicare and Medicaid.

"We don't know if the payer community is ready to do this," Escobio said.

TGH and the Pediatric Health Care Alliance said they successfully have tested their software with some larger insurers, but that does not mean it will align with all of them.

That's worrisome for medical providers, which worry that software compatibility issues or other snags could slow payments.

"We are afraid there will be a slowdown in our revenue cycle because of this," said Debra Gonzalez, executive director of the Pediatric Health Care Alliance.

Gonzalez said that although the new coding might help health care officials at the national level with large-scale analyses, she does not think it will provide much benefit to smaller practices, which use a relatively small number of codes.

"It doesn't really present us with any additional information we didn't already have," she said.

Escobio said the kinks eventually should be worked out, noting that the health care industry has worked through other difficult software changes, such as when it spent billions of dollars to accommodate the Health Insurance Portability and Accountability Act. Plus, he said, it is time the United States catches up with other countries such as the Czech Republic, where the new coding system has been used for more than 20 years.

Escobio said the long-term benefits should offset the initial payment problems.

"We've gone from a much more generic set of codes to a much better set of codes," Escobio said.

The new codes, he said, could help physicians better discern treatment options.

"We are going to have to be a lot more descriptive about the type of illness patients have," Escobio said.

Crystal McCullen, insurance and billing supervisor for Tampa pediatrician Teena Hughes, is not looking forward to the billing obstacles but said the system probably will improve health care.

"I think it's more beneficial," she said. "It's just going to take some getting used to."

Doctors, hospitals and insurance carriers will have to start getting used to the change quickly. After Wednesday, the old coding system officially will be obsolete and Medicare claims using that code set no longer will be processed.

The Centers for Medicare & Medicaid Services has been working for years to make the transition as smooth as possible. Patrick Conway, the centers' chief medical officer, addressed the concerns during a media conference call last week, saying the transition should not affect any Medicare recipients' routine checkups or other medical needs.

"They will still receive the care they need when they need it," Conway said.

Centers for Medicare & Medicaid Services officials will track the transition, Conway said, but it will take a few weeks to determine whether there are any problems. Even the possibility of a government shutdown from the fight over Planned Parenthood funding, he said, will not stop the changeover.

"In the event of a government shutdown, we will continue to pay claims," he said.

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