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More painful than an insect bite? ICD-10 cost-benefit for healthcare providers

Posted Dec 23 2008 9:35pm
That long overdue ICD-10 announcement finally arrived from CMS and comments on the proposed final rule were due this month.

You can take it to the bank that ICD-10 will ultimately be approved. ICD-9 is running out of codes to support the growing number of new high cost medical procedures.

But what about the overall healthcare provider financial cost-benefit?

To gain some insight on this, let's first look at superbills, which many providers use to allow for quick coding for reimbursement. The Blue Cross Blue Shield association just released a comparison of a current ICD-9 superbill to the equivalent using ICD-10. The new codes turn a 2 page superbill into a 9 page behemoth.

For example, an insect bite using ICD-9 is shown on the superbill as "919.4 Insect bite". (Thanks to an anonymous reader for the clarification that there are 18 ICD-9 insect bite codes of which 16 are specific to a particular body site and two are not).

Want to do the same thing using ICD-10? Here are your choices:

S00.06A Insect bite of scalp; Initial encounter
S00.06D Insect bite of scalp; Subsequent encounter
S00.269A Insect bite of unspecified eyelid and periocular area; Initial encounter
S00.269D Insect bite of unspecified eyelid and periocular area; Subsequent encounter
S00.36A Insect bite of nose; Initial encounter
S00.36D Insect bite of nose; Subsequent encounter
S00.469A Insect bite of unspecified ear; Initial encounter
S00.469D Insect bite of unspecified ear; Subsequent encounter
S00.561A Insect bite of lip; Initial encounter
S00.561D Insect bite of lip; Subsequent encounter
S00.562A Insect bite of oral cavity; Initial encounter
S00.562D Insect bite of oral cavity; Subsequent encounter
S10.16A Insect bite of throat; Initial encounter
S10.16D Insect bite of throat; Subsequent encounter
S10.86A Insect bite of other part of neck; Initial encounter
S10.86S Insect bite of other part of necks; subsequent encounter
S10.96A Insect bite of unspecified part of neck; Initial encounter
S10.96D Insect bite of unspecified part of neck; Subsequent encounter
S20.161A Insect bite of breast, right breast; Initial encounter
S20.161D Insect bite of breast, right breast; Subsequent encounter
S20.162A Insect bite of breast, left breast; Initial encounter
S20.162D Insect bite of breast, left breast; Subsequent encounter
S20.169A Insect bite of breast, unspecified breast; Initial encounter
S20.169D Insect bite of breast, unspecified breast; Subsequent encounter
S20.361A Insect bite of right front wall of thorax; Initial encounter
S20.361D Insect bite of right front wall of thorax; Subsequent encounter
S20.361S Insect bite of right front wall of thorax; Subsequent encounter
S20.362A Insect bite of left front wall of thorax; Initial encounter
S20.362D Insect bite of left front wall of thorax; Subsequent encounter
S20.369A Insect bite of unspecified front wall of thorax; Initial encounter
S20.369D Insect bite of unspecified front wall of thorax; Subsequent encounter
S20.461A Insect bite of right back wall of thorax; Initial encounter
S20.461D Insect bite of right back wall of thorax; Subsequent encounter
S20.462A Insect bite of left back wall of thorax; Initial encounter
S20.462D Insect bite of left back wall of thorax; Subsequent encounter
S20.469A Insect bite of unspecified back wall of thorax; Initial encounter
S20.469D Insect bite of unspecified back wall of thorax; Subsequent encounter
S20.96A Insect bite of unspecified parts of thorax; Initial encounter
S20.96D Insect bite of unspecified parts of thorax; Subsequent encounter
S30.860A Insect bite of lower back and pelvis; Initial encounter
S30.860D Insect bite of lower back and pelvis; Subsequent encounter
S30.861A Insect bite of abdominal wall; Initial encounter
S30.861D Insect bite of abdominal wall; Subsequent encounter
S30.862A Insect bite of penis; Initial encounter
S30.862D Insect bite of penis; Subsequent encounter
S30.863A Insect bite of scrotum and testes; Initial encounter
S30.863D Insect bite of scrotum and testes; Subsequent encounter
S30.864A Insect bite of vagina and vulva; Initial encounter
S30.864D Insect bite of vagina and vulva; Subsequent encounter
S30.865A Insect bite of unspecified external genital organs, male; Initial encounter
S30.865D Insect bite of unspecified external genital organs, male; Subsequent encounter
S30.866A Insect bite of unspecified external genital organs, female; Initial encounter
S30.866D Insect bite of unspecified external genital organs, female; Subsequent encounter
S30.867A Insect bite of anus; Initial encounter
S30.867D Insect bite of anus; Subsequent encounter
S40.269A Insect bite of unspecified shoulder; Initial encounter
S40.269D Insect bite of unspecified shoulder; Subsequent encounter
S40.869A Insect bite of unspecified upper arm; Initial encounter
S40.869D Insect bite of unspecified upper arm; Subsequent encounter
S50.369A Insect bite of unspecified elbow; Initial encounter
S50.369D Insect bite of unspecified elbow; Subsequent encounter
S50.869A Insect bite of unspecified forearm; Initial encounter
S50.869D Insect bite of unspecified forearm; Subsequent encounter
S60.369A Insect bite of unspecified thumb; Initial encounter
S60.369D Insect bite of unspecified thumb; Subsequent encounter
S60.468A Insect bite of other finger; Initial encounter
S60.468D Insect bite of other finger; Subsequent encounter
S60.469A Insect bite of unspecified finger; Initial encounter
S60.469D Insect bite of unspecified finger; Subsequent encounter
S60.569A Insect bite of unspecified hand; Initial encounter
S60.569D Insect bite of unspecified hand; Subsequent encounter
S60.869A Insect bite of unspecified wrist; Initial encounter
S60.869D Insect bite of unspecified wrist; Subsequent encounter
S70.269A Insect bite, unspecified hip; Initial encounter
S70.269D Insect bite, unspecified hip; Subsequent encounter
S70.369A Insect bite, unspecified thigh; Initial encounter
S70.369D Insect bite, unspecified thigh; Subsequent encounter
S80.269A Insect bite, unspecified knee; Initial encounter
S80.269D Insect bite, unspecified knee; Subsequent encounter
S90.463A Insect bite, unspecified great toe; Initial encounter
S90.463D Insect bite, unspecified great toe; Subsequent encounter
S90.466A Insect bite, unspecified lesser toe(s); Initial encounter
S90.466D Insect bite, unspecified lesser toe(s); Subsequent encounter
S90.569A Insect bite, unspecified ankle; Initial encounter
S90.569D Insect bite, unspecified ankle; Subsequent encounter
S90.869A Insect bite, unspecified foot; Initial encounter
S90.869D Insect bite, unspecified foot; Subsequent encounter

And that is just for insect bites.

Providers will clearly need to be prepared with education, software and process improvements to deal with ICD-10, in addition to complex transaction integrations and implementations. And transitional reimbursement challenges such as retroactive adjustments using different code sets will be entertaining, to say the least.

A recent study assessed the cost impact of the proposed ICD-10 rule on providers. For a typical 10 provider practice, the cost is $285,195. And for a large practice? $2.7 million.

CMS listed 6 reasons for the move to ICD-10:
  • More accurate payments for new procedures
  • Fewer rejected claims
  • Fewer improper claims
  • Better understanding of new procedures
  • Improved disease management
  • Better understanding of health conditions and health care outcomes
  • Harmonization of disease monitoring and reporting world-wide
Unless you're a provider managing risk, only "fewer rejected claims" and "fewer improper claims" have a potential favorable impact on healthcare providers' operating costs. And it's very likely those benefits have been overstated. For example, HHS treats all claims processing costs as variable to calculate the benefit of "fewer rejected claims".

In conclusion, the effect of these limited benefits and high costs could be more painful to providers than an "S30.867D".
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