August 30 2011
Transitioning to ICD-10-CM/PCS is Well Worth the Effort
I recently provided an overview of electronic health records (EHRs) to a new college graduate considering employment in the field. I described how access to clinical information at the right time significantly contributes to patient safety. I highlighted how clinicians can simplify their workflow by building personalized templates among care plans, order sets and notes, which they easily customize to each patient. I outlined the great advancements that can be made by querying the information for research sake. Most of all, however, I emphasized how exciting it is to be able to empower health care providers with use of the electronic health record during an unprecedented time of growth. Several regulatory initiatives will greatly accelerate responsible sharing and deeper use of information collected within the record. While I mentored my young friend on each of the upcoming initiatives, I stressed the importance of ICD-10-CM and ICD-10-PCS.
The International Classification of Diseases (ICD) is the international standard diagnostic classification for epidemiological, health management and clinical use. The World Health Organization (WHO) oversees ICD codes for the analysis of the general health situation of population groups. This data is also monitored for the incidence of diseases and other health problems in relation to variables such as reimbursement, resource allocation, quality and guidelines. The most recent version of the code, the International Classification of Diseases, Tenth Revision (ICD-10) was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as early as 1994. Some 25 countries use ICD-10 for reimbursement and resource allocation in their health system.
The United States has remained on the older version of the code. In 2009, the Department of Health and Human Services implemented a final rule to update the Health Insurance Portability and Accountability Act (HIPAA) of 1996, requiring the use of ICD-10-CM/PCS codes by Oct. 1, 2013. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) will address diagnoses, and will replace ICD-9-CM, volumes 1 and 2. US hospitals (inpatient, outpatient and other ambulatory services) as well as physician services will all convert to the new diagnosis codes. The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) will replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) volume 3, Procedures. ICD-10-PCS adoption is required in the US for inpatient procedure coding but it does not affect procedure coding for physician services (which use CPT-4) or for hospital outpatient or other ambulatory services (which use HCPCS).
I warned the enthusiastic scholar not to underestimate the impact of ICD-10-CM/PCS, nor the efforts required to prepare for the transition. ICD-10 codes are much more specific than the older version, requiring the code to expand from a maximum of 5 digits to up to 7 digits in length. While approximately 18,000 codes exist in the current ICD-9-CM system, more than 140,000 codes will exist in ICD-10-CM/PCS, increasing the volume of codes almost eightfold. This will challenge the clinical staff, especially physicians, to more specifically document details by which the diagnosis is coded. Hospital coders, who assist the clinicians in arriving on an accurate code, will thoroughly train for the transition.
ICD codes are used heavily in claims management. Diagnosis is a key factor of whether a claim qualifies for reimbursement and at what payment amount. Within the EHR, ICD codes may also be used as the key to finding specialized templates for condition-specific care plans, order sets and notes. Companies that develop software for EHRs are currently ensuring that these components are not hardcoded to ICD-9-CM codes, but rather are pointed to a table which will soon feature ICD-10-CM/PCS codes, and have the flexibility to point to other tables in the future.
While ICD-10-CM/PCS has so far been the quiet sleeper among the regulatory endeavors, health care providers will soon see much activity in preparation for the implementation date. A smooth, successful transition requires a well-planned and well-managed implementation process. Many health care organizations will begin adopting and testing new code in 2012, as well as training clinicians and coders in preparation for the go-live date.
Consumers of health care (patients) will see the impact of ICD-10-CM/PCS in medical billing statements related to appointments scheduled for Oct. 1, 2013 and after. During that October, and potentially for a few months following, clinicians and coders will be increasing their proficiency in use of the new codes. Claims may be more commonly returned to the health care organization for clarification. As a result, there may be a temporary delay in the resolution of payment and the arrival of medical billing statements.
The aspiring associate rightfully asked if transitioning to ICD-10-CM/PCS will be worth the effort. I, in all sincerity, affirmed that it will be well worth it. At the most basic level, every individual who works in health care wants to make a difference in the lives of patients, both today and tomorrow. In order to drive improvements in care, we must continue to empower insightful studies. It is essential to be able to drive to specifics when conducting research. Studies at a global, national or local level, even down to the individual health care organization level, all benefit by being able to query on a large group and compare within smaller subsets of subjects. To this end, the new ICD codes will help us further differentiate diagnosis categories and potentially discern important insights. These studies, and use if the most recent ICD codes, will ultimately drive improvements in care for our patients and our loved ones.
My final advice to the new graduate was to consider a profession in EHRs only if she has a lot of energy. The comment period has just begun on the alpha draft of the International Classification of Diseases, Eleventh Revision (ICD-11).
Lisa Franz, CPHQ, is the Intellectual Capital Strategist for the Electronic Medical Record Agile Business Unit at Cerner Corporation, which ensures that solutions are designed, built and implemented to enhance clinical and business practice. She creates implementation strategies for EMR solutions supporting Meaningful Use at all venues, as well as strategies supporting the full spectrum of care at pediatric hospitals and academic medical centers. She joined Cerner in 2002 as Operations Lead for US Transition Management. Franz is a former Director of Strategic Planning and Director of Performance Improvement within health care organizations. She holds a Master of Business Administration degree with a focus in organizational behavior and is a Certified Professional in Healthcare Quality.