California Begins Transition To ICD-10
California's healthcare enterprises officially transitioned to the ICD-10 system as of today, implementing one of the biggest shifts in the way patient care is coded and billed in decades.
It remains to be seen whether there will be any glitches with the transition, which vastly expands the number of codes for medical incidents and care. For the moment, the state's Medi-Cal program will be sitting out the ICD-10 transition.
The expansion changes the ICD codes from three-digit to five-digit numbers to alphanumeric codes with three to seven characters. The number of available codes has expanded more than five-fold, from 13,000 under ICD-9 to more than 68,000 under ICD-10.
Some big providers, such as the UC San Francisco Health system, have been prepared for the transition for much of the past year. USCF began coding claims in both ICD-9 and ICD-10 in January, according to Amelyn Culver, the health system's ICD-10 transition lead.
“Every single diagnosis has been associated with ICD-10 and ICD-9,” Culver said. UCSF intended to “flip the switch” to ICD-10 as of midnight on Sept. 30.
Blue Shield of California made the official transition to accepting claims coded forICD-10 in August, the company said. Its software system was officially upgraded to ICD-10 compliance in 2014, although it has been conducting spot testing since January. The San Francisco-based health plan told hospitals in July that it would automatically reject any claims incorrectly coded for ICD-10, although it also has a transition team specifically trained to respond to any issues from providers.
Anthem Blue Cross said it was also ready. Last month it issued a statement that read in part: “All system development and implementations, business configuration and content type changes, and internal testing have been completed. We have successfully implemented the necessary updates of our systems, supporting business processes,policies and procedures without interruption to day-to-day business operations. Our vendors’ interfaces and extracts are also ICD-10 compliant.”
Others in the provider community have been quiet about the transition. Both Scripps Health, the multi-hospital system in San Diego and Cedars-Sinai Medical Center, the largest hospital in Los Angeles, were unable to respond to requests seeking comment. Spokespersons for both organizations suggested their ICD-10 preparedness was solely the domain of their IT departments, and neither were issuing answers.
Not every large healthcare player in California has been able to successfully make the transition. The California Department of Health Care Services (DHCS), which oversees the Medi-Cal program, was among four Medicaid program operators that received a delay in ICD-10 compliance from the Centers for Medicare & Medicaid Services. Along with Louisiana, Maryland and Montana, California's Medicaid program will “crosswalk” all ICD-10 codes to the old ICD-9 format until DHCS can update its aging IT systems.
The crosswalking technique is widely used in the laboratory sector, which is currently transitioning from tests that are often decades old to molecular-based assays that often perform multiple tasks and are priced much differently.
“The crosswalk will only be used temporarily for ICD-10 claim adjudication while the implementation of our new...system is being completed,” DHCS said in a statement. “Once the new system is online, Medi-Cal will adjudicate all claims natively using ICD-10.” The agency did not say when the transition would take place, and it has not released its crosswalking formula.
In terms of the ICD-10 crosswalking, payments are expected to be about the same, officials say. And while DHCS is not yet ICD-10 compliant, all claims will have to be submitted in ICD-10 code.
Meanwhile, there have been some questions regarding the preparedness of smaller medical practices to make the transition.
In June, the California Medical Association issued a study concluding that 51% of respondents were only minimally prepared to make the ICD-10 transition, while 21% said they were not at all prepared.
