Total costs of ICD-10 conversion could reach $3B for insurers

Making the switch from the ICD-9-CM to ICD-10-CM/PCS codes sets will add greater laterality and specificity to an outdated coding system. However, overall systemwide costs for insurers could reach $2 billion to $3 billion, according to an analysis published in September by America’s Health Insurance Plans (AHIP).

The survey of 20 insurance plans estimated that the average per-member ICD-10-CM/PCS code adoption costs would be $12, ranging from $38 for small health plans with less than 1 million members to $11 for large plans with more than 5 million members.

The total costs of ICD-10 implementation are estimated at $99 million, $293 million and $1.3 billion, for small, medium and large practices, respectively.

In addition, on Oct. 6 the National Quality Forum (NQF) released guidance outlining the best practices for converting to the ICD-10 coding system by the compliance date of Oct. 1, 2013.

"Performance measurement standards and specifications must evolve to reflect the shift in national coding standards and the healthcare system's evolution toward electronic platforms," said Janet Corrigan, PhD, NQF president and CEO. "We know there is much work to be done to convert measures to conform to updated code sets. This guidance is a starting point for both NQF and measure developers in helping prepare for the transition and move smoothly into new and updated measures."

The NQF guidance delineates the:

• Differences between ICD-9-CM, ICD-10-CM/PCS and SNOMED CT code sets and their impact;
• Equivalency of code sets and populations;
• Impact of code transitions on measure integrity;
• Current practices and required resources for conversion;
• Methodologies for converting code sets;
• Recommendations for NQF measure submission and maintenance processes involving multiple code sets; and
• Implications of additional code sets, coding changes and coding equivalency on measure development and submission.

Under the implementation of the ICD-10 code sets, the number of codes will jump from almost 17,000 to 155,000, due to the inclusion of additional procedural and diagnosis codes to better document the increased number of conditions and treatments.

For example, currently under ICD-9, angioplasty has one code. With ICD-10, the number of codes for angioplasty will jump to 1,170 to more accurately describe the location of the blockage and devices used during treatment.