ICD-10: Keep the Train Moving

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 - Train

The official transition from ICD-9 to ICD-10 was scheduled for Oct. 1, 2013, but pressure from the American Medical Association and other organizations has led to a one-year delay in that timeline. Some organizations, however, say they’ve come too far to stop now.

MD Anderson Cancer Center in Houston has been working toward the transition to ICD-10 for more than four years. “We positioned ourselves to be ready for the Oct. 1, 2013, deadline,” says Carol Smith, MBA, RHIA, the provider’s health information management director. The facility conducted its own initial assessment and then hired its “vendors to come in behind and validate our findings,” she says. That process is completed and “we are now in phase two of starting remediation of our systems.”

There will be a total of four phases at MD Anderson, including follow-up after the actual implementation. Smith views the transition as a relaunching of the organization’s clinical documentation improvement program which was piloted in the past. “We already have documentation issues with ICD-9, and we feel that those issues are going to be much worse with ICD-10.” That includes getting clinicians to use more specific language, so the coders can fully interpret cases.

At Centura Health, a 13-hospital system based in Englewood, Colo., “We’re moving ahead with most of our planned and scheduled activities regarding ICD-10,” says CIO Dana Moore. The organization is proceeding with computer-assisted coding, as well as a clinical documentation improvement system. Centura has gone ahead with “all system upgrades for ICD-10,” he says, having polled its vendors on where they stand on ICD-10 preparation.

Centura is fortunate, according to Moore, because the organization has done a lot of work over the past several years standardizing and upgrading its core clinical systems. That put them ahead of many other health systems, he says. Centura is “moving ahead with the initial phase of coding education including anatomy, physiology, medical terminology and coding guidelines. Anticipating a need for 14 new coders, Centura recently began its own coding school. “We’ve found it’s very hard to recruit experienced coders. They’re hard to find and always have been,” Moore says. So, Centura will create its own coders.

Centura recently rolled out electronic physician documentation on a voluntary basis. Moore says it’s a good time to tie that effort into ICD-10 and implement across the system. The organization also has started its first hospital on computerized physician order entry. “Once physicians had to put orders into the computer, their documentation tripled in a week.”

Spreading the word

The Tennessee Office of eHealth Initiatives will offer a traveling symposium on ICD-10 for the state’s physicians because there isn’t enough information available about what adoption “means in the exam room and at the bedside to providers,” says Russell B. Leftwich, MD, CMIO. “It is a much more granular codeset that is closer to the way physicians think about patients, which is good. It’s also far better as a quality measurement and improvement tool than ICD-9. That’s very important.”

Claims-based quality measurement means improvement really will be meaningful with ICD-10, Leftwich says. “Providers aren’t aware of that aspect of ICD-10. They just think of it as a more complex coding task and respond by sending their administrative staff to workshops.” His traveling symposium will address the documentation aspect of ICD-10 from the provider’s standpoint. “You can’t document at the coding desk. You have to get it right in the exam room.”  

One example of how ICD-10 is better for clinicians and patient care is his own experience treating patients with asthma. ICD-9 only has two codes for asthma, which is misaligned with today’s understanding of the disease. “They are beyond inadequate,” Leftwich says. “ICD-10 is a great improvement in that it allows us not only to reflect triggering factors and the nature of asthma, but also code for the state and severity of disease. Under ICD-9, you couldn’t tell whether somebody only had an asthma attack when a cat was present or whether he or she had asthma all the time. That’s really disabling from a patient care standpoint.”

Don’t delay: Test and assess

When it comes to the delay of ICD-10 implementation, Leftwich says many organizations that have committed to the original time line probably can’t change now. “If you’ve signed a multimillion-dollar contract to upgrade your software, you can’t just tell the vendor never mind.”  

He says there probably are a lot of providers, especially smaller healthcare settings, that were really behind in terms of readiness for ICD-10 implementation. Smaller hospitals, particularly critical access hospitals, struggle with both the capital and the IT support to make the technological changes, Leftwich says.

Moore concurs that many physician practices, small facilities and rural hospitals likely welcomed the delay. While the delay was not his personal preference, he says the one-year delay offers a little peace of mind. Any longer and “providers would start running into very significant costs.” He had worried about testing for HIPAA Version 5010 transaction sets. “5010 was supposed to be the easier of the two and we encountered a 90-day delay there,” says Moore, adding that most providers had hiccups around 5010 because the payors were not ready.

A delay in implementation is cost-prohibitive for a lot of organizations, Smith says. “The longer we drag this process out, the more testing and mediation might be necessary.”

For organizations that have not made much progress on ICD-10, Smith says they should “at least assess their needs” because that would help with prioritization. “We initially identified 80 systems that might need to be remediated. However, once we discovered exactly how they are used after evaluation, we realized that some of those systems are secondary and can be addressed much later.”

The assessment piece of implementation is huge. “At least know what you don’t know,” advises Smith, who also suggests identifying the education needs of clinicians and coders, as well as which systems touch your revenue cycle, because that “is going to be critical.” External reporting is important as well, she says. “You need to know that you can effectively communicate that information.”

Moore suggests other providers not wait when it comes to implementing ICD-10. “It’s a massive overhaul. I’m relieved that one year is the maximum that the government is going to delay. Time for additional testing is not a bad thing.” He suggests everyone continues with their implementation plans as though the deadline is still 2013, because “you will have issues you don’t expect. Yes, you got a little bit of a reprieve, but we still have to get the work done.”