ICD-10 Global Lessons, More on Parallels with Canada and Australia

ICD-10 implementation and ICD-10 assessments are new to U.S. health system, so many are looking for parallels and lessons learned from other countries.

In a recent blog, we noted that there are many reasons that the U.S.  Implementation of ICD-10 will be different.  In particular ICD-10 CM is larger than the WHO version of ICD-10, and in the U.S., ICD-10 will serve as a new reimbursement paradigm, unlike Canada.  However, as we noted there is one big similarity – more planning is always better.

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ICD-10 Canada implementation

Here are a few more areas to consider:

In addition to the US ICD-10 CM implementations for diagnosis codes, there is the issue of the procedure side implementation (ICD-10 PCS) supported by CMS in the US.

Second, coders are a critical component and will need extensive training for anatomy and physiology, and the understanding of surgical procedures. The new surgical descriptors will be approximately 87,000 in vs. the ICD-9 of 3,500.

Third ICD-10 includes the cause of the diagnosis.

Fourth, for medical policies, a brief three line rule under ICD-9 to pend, pay or deny a claim may expand to as much as 300 lines in a software system to express the complex business logic.

Several  lessons learned in other implementations (Canada, Australia), have included the need for accountability, and well-defined areas of responsibility with sufficient resources.  As departments have existing responsibilities it is critical to separate those responsibilities from those required for the ICD-10 implementation, and the project timelines should allow adequate time for sufficient testing.

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Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

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