The proposed switch from ICD-9 code sets to ICD-10 will be a huge information technology challenge for the U.S. healthcare system, but some folks are eager to answer the call.
HHS issued a proposed rule that would update regulations under the Health Insurance Portability and Accountability Act of 1996 to require the use of the International Classification of Diseases, 10th Revision, for diagnosis coding and for inpatient hospital procedure coding, according to an HHS announcement, replacing related International Classification of Diseases, Ninth Revision, codes. It also sets an Oct. 1, 2011 deadline for adopting the new codes for the electronic processing of claims, remittance advices, eligibility inquiries, referral authorizations and other electronic transactions.
The movement to the ICD-10 code sets, which have achieved wide adoption around the world but whose rollout had been delayed in the U.S. because of the high cost of switching existing IT systems to accommodate them, will allow clinical IT systems to record in codified form a much more specific and rich diagnosis than ICD-9 codes. According to HHS, the ICD-10 codes contain more than 155,000 codes and can describe far more diagnoses and procedures than the ICD-9 series, which contains 17,000 codes.
The American Health Information Management Association, a professional association, long has been an advocate for the conversion to ICD-10.
"We've very excited," said Sue Bowman, AHIMA's director of coding policy and compliance.
"We've been working on trying to get ICD-10 implemented for a number of years now, so we're very happy to have it come to fruition."
Bowman said that the ICD-10 codes, developed by the World Health Organization, were first introduced in the 1990s and have since been adopted throughout much of the industrialized world for eight to 10 years. The ICD-10 codes have been in use in the U.S. since the late 1990s to record public-health data on causes of death, but the codes have found little traction here for other uses, Bowman said.
"We're the only developed country now that has not implemented ICD-10," Bowman said. "The rest of the world looks at us and shakes their head and wonders why it takes so long to get to this." One reason for the foot-dragging, she said, is the U.S. uses coding more intensively than other countries for diverse things, such as medical billing. But that intensity would also argue that a better coding system would be essential, she said. Pay-for-performance, patient safety and other quality improvement regimes that are increasing here in the U.S. will be better equipped with the more granular, ICD-10 coding system, she said.
Bowman said it's too early for AHIMA to opine on whether the 2011 deadline is doable.
"We've not had a chance to evaluate the full rule, so we haven't talked about that yet," she said.
Bowman said there is no reason to panic, even if the 2011 deadline holds fast. In fact, preparations at AHIMA are well under way to get the workforce training infrastructure ready for the big switch.
"We've been doing presentations for years already," Bowman said. "We already have some ICD-10 products, training programs, books and online programs. We've already had to upgrade our curriculums." Schools with health information management degrees "already started to gradually incorporate ICD-10 in their programs, which they will gradually increase as time marches forward."
At the healthcare facility level: "We've been saying all along there were plenty of things people could be doing to prepare for ICD-10, such as buying or updating computer systems, making sure they're ready for ICD-10 so it doesn't have to be retrofitted. Our understanding is some of the big vendors have been looking at that and some have international clients," which should help with ICD-10 preparedness, she said.
Bowman also offered a quick rundown of steps hospitals and practices could take now to get ready, beginning with making lists and checking them twice.
"Start looking at every place in your institution, the forms, systems and interfaces, to see where you use ICD-9 codes now that have to be updated to ICD-10, so you can see the magnitude of that," she said. "Also, talk to systems vendors to see whether they are ready for ICD-10, and, if not, is that going to be included in the vendor maintenance contract. Some vendors have included regulatory compliance as part of their standard maintenance contract. So they (provider organizations) need to look at that to see who is going to pay for it."
Personnel preparedness is another consideration.
"Obviously, coders are going to need extensive training," Bowman said, but timing is important. "Based on research we've done at AHIMA, from a coder perspective, that group doesn't want comprehensive training until about six months before implementation. Training the trainers would need to be done before then." Quality management and registration personnel will need to be trained, so "identifying who they are and what level of training they will need," should be on another list.
Financial preparedness is another item.
"Initially, with any new change, we expect some impact on productivity, but we expect that to be temporary," she said.
And for health information management professionals, particularly those at entry-level, routine coding positions, it's time for them to upgrade their training in IT.
"We expect these new codes will be good for technology, they are more amenable to electronic record systems, which will mean higher productivity," Bowman said. "Hopefully, it will have an impact on our coding shortage, where they won't have to be doing as much coding manually, because there will be more powerful coding tools. In the manual coding area, we've always said, it will reduce the number of coders to do the mundane, routine coding, but there will be a lot more high-level, health information jobs."
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