That the U.S. House of Representatives passed the so-called Healthcare IT bill (H.R. 4157) at the end of July is not a big surprise; that it could — depending on reconciliation with the Senate version of that bill — force the healthcare industry to transition to ICD-10 coding by Oct. 1, 2010, however, is big news.
Endorsed by the World Health Organization in 1994, the International Classification of Diseases, the 10th revision (ICD-10) is much more flexible than ICD-9, which has been used for coding over the last 30 years, as medicine has vastly changed and expanded. ICD-10 has been adopted in a number of countries and has been anticipated in the United States for more than a decade.
The United States does use ICD-10 for mortality reporting, but not for morbidity reporting or procedure reporting in hospitals and healthcare settings.
The industry seems to have formed two sides on the issue, with organizations such as the American Academy of Dermatology Association, the American Clinical Laboratory Association, the Blue Cross Blue Shield Association and the Medical Group Management Association coming out in strong opposition to the 2010 goal. Those groups argue that, with other projects on their plates — such as the ANSI X12 version 5010 and Medicare contracting changes — they need at least until 2012 to tweak their systems for the changeover.
They point to "Due in part to ICD-10's more than 200,000 codes compared to the current 24,000 codes in ICD-9, implementation of ICD-10 will require vast changes to computer systems and extensive training of clinical and administrative personnel," a coalition of health organizations stated recently.
Regardless of the date, some are strongly in favor of ICD-10.
"It can reduce the cost of transitioning if people start thinking about these issues now," emphasizes Sue Bowman, RHIA, CCS, director of coding policy for the American Health Information Management Association (AHIMA). The structure of the older system, says Bowman, "wasn't intended to deal with the level of detail and specificity that is demanded today."
She says, for example, when ICD-9 was created the only way to do most surgeries was to operate. Now some of the same procedures are done with endoscopy and other methods, but it is impossible to reflect those with the current codes.
"There are some codes so vague that they actually include hundreds of individual, different procedures that are all classified to the same code," she adds.
George Arges, senior director of the health data management group of the American Hospital Association, says professionals should be planning now — as more electronic health records are being adopted and other changes are made — to avoid retrofitting systems later. He also advises facilities to be sure vendors' products are ready to accommodate ICD-10, including its character length and code structure.
Bowman agrees, even though, as she notes, the new national certification process for ambulatory electronic health records does not include ICD-10 readiness as one of the standard requirements.
Arges also advises planning into the future for the significant time requirements that will be needed for training staff on ICD-10.
One payoff for all the work the transition will require, says Bowman, is that ICD-10 will make billing more efficient in some ways. Currently, with ICD-9, providers often must supply additional medical records or other documentation with their claims to complete the information on the patient's condition or a procedure. AHIMA believes those attachments will be significantly reduced when a specific code says it all.
Also on the positive side, Arges says staff will know much more precisely what diagnoses and procedures are being dealt with in their own organization, whether the need is for research, for reimbursement or for a facility's internal plans.
AHIMA has extensive information about ICD-10, including a two-to-three year plan for preparing, both from a systems and a health information management perspective, at www.ahima.org (click under "HIM resources").
Kathryn Foxhall is a contributing writer based in Hyattsville, Md.
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