We are anticipating the DWC announced transition to ICD-10 at the end of this year. The DWC had public comment on the 16 pages of proposed new regulations from March 18, through March 28, 2014 and the comment period is now closed. Only one half page of comments were received. Most of the half page consisted of questions by one poster rather than comments, and the only substantive comment was made by Bennett Katz of Zenith Insurance Company and involved a technical error in the proposed regulations concerning the number of digits specified in the codes.
ICD-10 is not simply an upgrade of the current ICD-9 code, it is a total rewrite, intended to provide better detail and data collection for physicians, hospitals and payers.
This detail comes at a price. The sheer volume of these codes, increasing fourfold over the current ICD-9 standard, brings a real set of challenges for workers’ comp adjusters who are expected to quickly review these codes for appropriateness and relatedness on incoming bills. For these adjusters, any additional time spent deciphering these 68,000 codes means less time spent getting injured workers back to work, more jurisdictional penalties as delays impact payment, or higher medical spend as inappropriate bills sneak through.
ICD-10 will offer a much greater level of detail for companies ready to accept the additional data detail. One thing that ICD-10 will do is specify between right and left on bilateral body parts and make a distinction between acute and chronic treatments. This will increase the accuracy of the diagnosis and treatment which will reduce costs by cutting down on unnecessary testing. More detailed data may lead to better preventive safety protocols as a result of identifying the specific source of injury. This data is also helpful in forecasting or predicting trends in medicine. Medical technology and treatments are constantly evolving and improving, and ICD-10 accommodates new breakthroughs in treatments. ICD-10 can allow for comprehensive reporting which will be useful for determining risk and effectiveness of other programs. The impact of ICD-10 on adjusters will be significant if not managed properly.
Once the system is in full swing and everyone becomes more familiar with the codes it may help cut down fraud and abuse. Injured body parts will be more definitive and treatments will be more concise. It will make it harder for a doctor to add a CPT code that is completely unrelated because the ICD-10 will be so very specific. Technology can be a help to payers and adjusters, who need to embrace change and realize that evolving technology will decrease their workflow and enable them to close claims faster. Automating certain aspects of the system will allow adjusters to be two or three steps ahead of a claim to keep it from spiraling out of control rather than always being on the defensive end of a claim.
Whether you are a fan ICD-10 or not, it’s coming; there is no stopping it come October. Time will tell how this affects the workers’ compensation industry.