Electronic Health Records

Policy & Regulation News

What impact does Version 5010 have on ICD-10?

By Kyle Murphy, PhD

- While passing through HIPAA Version 5010 on the road to ICD-10, no one’s asking, “Are we there yet?” Instead, everyone, from large organizations to small providers, is mired in a process to transition from one set of transition codes to the next version and upgrade from one diagnoses set to the latest edition. Amidst all this confusion, it’s easy to miss the forest for the trees. Unless lessons are learned right now, this process will repeat itself each time a change is mandated.

The challenge is not change itself but the sheer volume of changes to be made during a brief period of time. “The biggest challenge is the competing priorities, and that’s what we hear in the industry right now,” argues Andrew Fitzpatrick, CEO of Washington Publishing Company, “If you think about ICD-10, the impact even to a health system or a provider is significant. The actual coding is less significant than every other system that touches it.”

While the transition to International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) is occupying most of the public debate at this moment (and rightfully so, considering that the comment period on the proposed change closed May 17), the enforcement period for Version 5010 is fast approaching on July 1. And truth be told, any chance of successfully moving to ICD-10 requires a long look at the challenges of going to Version 5010: “The question is, have enough lessons been learned through this 5010 experience?”

The system-wide adoption of Version 5010 and ICD-10 involves both providers and payers making changes in the way they do business in healthcare, and neither side sees the situation the same way. Whereas insurance companies and larger health systems have fared reasonably well, small providers have faced significant challenges

READ MORE: CMS Issues Provider Contact Sheet for ICD-10 Code Questions

With the provider side, there’s the concern about pending claims as well as denials, and then there’s obviously the cash flow problems. Also, you have the introduction of a new transaction set in certain parts of the industry that a lot of these providers were unprepared for . . . The providers have a double challenge in this in conjunction with ICD-10.

A delay in ICD-10 compliance may allow these struggling individuals and practices a chance to catch their breath; it means nothing unless they take advantage of this extension. “It’s still kind of late in the game if you haven’t looked at it already,” notes Fitzpatrick.

Thinking short-term

With any major project, proper planning is what determines positive outcomes. With ICD-10, it’s no different. So what has the experience in Version 5010 taught us about successfully transitioning from old to new standards?

1. Assess the situation. All stakeholders in the project need to be aware of what’s at stake. “Spend the money on that assessment because you’re not going really understand the business impact until you’ve completed a thorough investment,” continues Fitzpatrick, “Organizations that have already done their assessment or are working on them right now are going to be much better prepared in terms of quantifying what is the remediation effort and what really makes sense.”

READ MORE: 93% of Healthcare Professionals Fear ICD-10 Payment Delays

2. Make the transition a priority. “We’ve worked with a couple of large health systems on the provider side and a couple of relatively smaller physician practices that did make this a priority two years ago preparing for 5010 and were ready,” observes Fitzpatrick.

3. Start sooner rather than later. According to Fitzpatrick, these groups that began the ball rolling early on save themselves unnecessarily high costs: “Their relative cost to transition to 5010 was very insignificant compared to some of those we have worked with in the last six months.”

4. Test the system. The downside to these delays is that early adopters are restricted in the amount of testing they can do. Of the groups his consulting team has worked with successfully, “both those examples have been frustrated because they haven’t found payers to test with them.” Very few systems launch with a hitch or a hiccup — just ask anyone who’s worked as a web developer. It’s crucial that all trading partners (i.e., providers and payers) work together to fix any bugs early on.

Thinking long-term

By this point, you might be wondering what great visionary decided that all these changes should go on at once. And add to them incentive programs and other grants offering significant payouts with their own set of competing deadlines. “We’ve got some real interesting times ahead of us. They’re going to go well into the next five years beyond 2014,” says Fitzpatrick.

READ MORE: ICD-10 Success for Large Practices, Problematic for Small

Version 5010 and ICD-10 aren’t the end of the road. There will be 6020 and ICD-11. In order to prepare for future changes, it’s time for everyone to get on the same page:

The industry as a whole would fare better if we saw these version changes every two to three years so that they’re small, incremental changes. Going from 4010 to 5010 is a significant jump. Going from ICD-9 to ICD-10 is a significant jump. If we saw these changes every two to three years instead of every ten years (or with ICD-10 every twenty years), they would be significantly less of a challenge for organizations to deal with.

According to Fitzpatrick, at least one group is already getting with the program. The Accredited Standard Committee X12 (ASC X12), which comprises volunteers from the electronic data interchange industry, has recognized the need to respond current difficulties in transitioning to new standards: “X12 being the standards body has developed the next version, which is called 6020. It went out for public review earlier this year. X12 decided that they were going to go ahead and publish it, but they’re not going to recommend it be adopted.”

It’s a start, albeit a small start. The next step is to get everyone around the table and coordinate realistic timelines for standards implementation. “What we’re going through now with healthcare is that all of these standards weren’t necessarily harmonized or coordinated as well as we would like,” contends Fitzpatrick.

Mind the gap

So how do you get from ICD-9 to ICD-10? According to Fitzpatrick, it’s all about bridging the gap using information already at your disposal.

One of the things we found has been well received is looking at the last five years and building a crosswalk, looking at the last five years and what the impact to revenue for the whole payment processing cycle would be in real dollars if we had been to ICD-10. Play through a scenario and make sure you can quantify what that looks like over just historical data.

In simple terms, this means working more collaboratively with existing business partners, especially for providers: “Work with your top-five or top-ten payers and explain your situation and challenges and see what they can to do to help.”


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ICD-10 is about more than better diagnoses. It’s also about streamlining an industry whose coding and reporting systems are full of many twists and turns. The experience of Version 5010 should improve the experience with ICD-10. If it does not, then all individual and organizations involved in the process have failed to forge true partnerships that are less about just finances and more about good business.


Related Articles:

• Will the healthcare industry ever really change?
• What the 3M Healthcare Data Dictionary means to interoperability
• AHIMA comments on ICD-10 compliance delay
• Proposed change to ICD-10 deadline open for comments
• ICD-10 delayed til 2014

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