LAS VEGAS – When it comes to ICD-10 implementation, hospitalists aren’t in for the kind of hassles – or the crushing expenses – that office-based physicians face. But they can expect to spend more time selecting diagnosis codes and to get more questions from hospital coders and other providers, Dr. John Nelson said at the annual meeting of the Society of Hospital Medicine.

All physicians and hospitals begin using the new coding set starting on Oct. 1, 2014, according to the Centers for Medicare & Medicaid Services. And anyone who does not transition to the new system on that date will have their claims rejected.

Private payers, clearinghouses, and IT vendors are rushing to make the switch by Oct. 1.

*But there is a possibility that physicians will get some extra time to prepare for ICD-10. The House voted on March 27 to delay ICD-10 implementation for one year, pushing it back to Oct. 1, 2015. The bill (H.R. 4302) must make it through the Senate for the delay to take effect and it’s unclear if it can pass that chamber. The Senate is scheduled to vote on the issue on March 31.

Most hospitalists won’t need to lead this transition in their groups, but they do need to make sure that someone is making the transition happen, said Dr. Nelson, a hospitalist at Overlake Hospital in Bellevue, Wash., and a principal at Nelson Flores Hospital Medicine Consultants.

That means ensuring that charge capture and billing vendors are compliant, arranging testing for payers well in advance of the Oct. 1 deadline, and scheduling training and practice time for physicians, nurse practitioners, physician assistants, and billing personnel.

The major impact of the switch to ICD-10-CM (the version used by hospitalists and physicians who are not performing procedures) is a significant increase in the number of available codes. There were about 14,500 codes under the ICD-9-CM, but that will jump to more than 69,000 under ICD-10-CM, Dr. Nelson said.

While there are new diagnoses within the set, the bulk of the increase comes from adding greater specificity to the codes. For instance, there are now separate codes for specifying if a condition is "right" or "left" or if the visit is an "initial" or "subsequent" encounter.

"It’s not as bad as you think," Dr. Nelson said.

But some changes could be tricky for hospitalists. The new code set uses combination codes that allow physicians to classify two diagnoses together or a diagnosis with an associated secondary process or complication. For example, under ICD-9, physicians would use one code to denote a pressure ulcer on the ankle and another to indicate that it was stage 1. Under ICD-10, there’s a single code for pressure ulcer of unspecified ankle, stage 1.

All the new options mean it could take longer to choose codes correctly each time, Dr. Nelson predicted. And it’s also likely to mean more time will be spent responding to queries from hospital coders who are looking for more clinical documentation to support those codes.

The goal behind switching from the 30-year-old ICD-9 code set to a new system is to keep up with changes in medical practice and technology, as well as to gain more specific epidemiologic and population health data.

"Assuming we all choose these codes correctly, we will have a very useful data set," Dr. Nelson said.

Supporters of ICD-10 also say that it will cut down on rejected claims because it will provide more information from the start. Dr. Nelson said that he’s supportive of the switch to ICD-10, but is skeptical that it will cut down on the number of rejected claims. In fact, he thinks the opposite will be true, at least at the beginning.

So what can hospitalists do to prepare? If they haven’t heard from their hospital administrators about plans for the ICD-10 transition, it’s time to start asking questions, Dr. Nelson said.

It isn’t necessary for hospitalists to become ICD-10 experts, he said. Instead, lean on the hospital to provide support in the form of coding crosswalks between the two systems, cheat sheets, and even upgraded electronic health record software to aid in appropriate coding.

One potentially positive outcome of the switch is that it could make the process so complex that it will force hospitals to take diagnosis coding out to the hands of physicians.

"I think there’s a possibility that ICD-10 will go badly enough that others will swoop in and say ‘let us take care of that for you,’ " Dr. Nelson said. "That might ultimately be a very good thing for us."

mschneider@frontlinemedcom.com

On Twitter @maryellenny

*Updated 3/28/2014

Get ready for ICD-10 speed bumps