HIMagine That! The Real Deal with ICD-10 Financial Impact

November 15th, 2012 / By Sue Belley, RHIA, Donna Smith, RHIA

Sue:        What’s this buzz I am hearing about the negative financial impact of ICD-10? I thought CMS said that MS-DRGs determined under ICD-10 should replicate the payment generated using the ICD-9 MS-DRGs.

Donna:   That’s exactly what CMS said, but there’s so much misinformation out there,   there’s a real sense of panic.  Remember when we went to the AHIMA ICD-10 Summit last April and there was a speaker who warned about “huge financial implications” in going from ICD-9 to ICD-10?

Sue:        How could I forget? I had to listen to you rant about it. You were really incensed that the speaker was creating fear with incorrect information and no specific examples to support his case.

Donna:   Yes, but some of the attendees didn’t understand this and were very nervous about reporting this information back to their financial folks.

Sue:        So, what is the real story?

Donna:   CMS has indicated that it wants to replicate the MS-DRGs, so if a claim is coded natively in ICD-9 and then again in ICD-10, the resulting MS-DRG should be the same in most cases..  There are a few exceptions to this based on changes to specific coding of some diagnoses or procedures in ICD-9 versus ICD-10, as well as a few coding guideline changes.

Sue:        Like the coding guideline change for reporting anemia due to a malignant neoplasm? In ICD-9, this is reported using anemia as the Principal diagnosis, but in ICD-10, the malignant neoplasm is reported as the Principal diagnosis.

Donna:   Right.  And the other changes involve CC and MCCs that have changed from ICD-9 to ICD-10, like malignant hypertension is a CC in ICD-9, and in ICD-10, malignant hypertension is coded the same as benign hypertension with all reported using the code I10. So in ICD-10, the I10 code is no longer a CC.

Sue:        I’ve also heard that many of the surgeries are changing and that this can be a larger impact than a change in a diagnosis.

Donna:   Remember that speaker I mentioned earlier? He indicated there would be a huge shift in Medicare payment for cardiovascular procedures. In reality, that wouldn’t happen if you assigned a code natively in ICD-10. It might appear to be the case if you use the GEMs to translate rather than actually coding the case natively. The point that the GEMS should not be used for coding can’t be stressed enough.  (sighs) We really need someone to provide accurate information about the true financial impact of ICD-10.

Sue:        Well, Donna, I think you just did.

Sue Belley is a Project Manager with the Consulting Services Business of 3M Health Information Systems.

Donna Smith is a Project Manager and Senior Consultant with the Consulting Services business of 3M Health Information Systems.