Quite simply, we are running out of codes,” says Don Bechtel, a board member of the Workgroup for Electronic Data Interchange (WEDI). The nation's long-anticipated transition from ICD-9 to the ICD-10 coding system is aimed at alleviating this problem, and though it may seem like a back-burner issue, there are strategies a CIO should be thinking about to be proactive.
Most agree that ICD-9 is woefully outdated. “With ICD-9, we're not capable of fully explaining medicine as we know it today,” says Dan Rode, Chicago-based American Health Information Management Association's (AHIMA) vice president of policy and government relations. “With ICD-9, we can't even talk about severity.” That's in addition to its inadequacy in providing information for quality reporting, public health reporting and bio-surveillance — or even something as simple as specifying right or left side of a patient.
Rode believes that part of the problem with the slow adoption of ICD-10 is that the United States tends to think of ICD as a billing code, when in reality it was built to do a whole lot more. “It was built essentially for public health purposes. People don't think about that because it's more like, ‘As long as I can get paid, I'm OK,’” he says. “As we try to automate public health, you want a code system that allows providers to send the code through the system, and get information back on how to treat.
Eventually, Rode says, ICD-10 will allow more automated, computer-assisted coding — and coders will turn into editors.
ICD-10 will use a seven-character alphanumeric system, as opposed to ICD-9's five-character numeric system. “I think it's important to start thinking of terminology as a part of the system,” says Stan Huff, a co-chair of Ann Arbor, Mich.-based HL7. “The reality of going from ICD-9 to ICD-10 is you're increasing the number of codes dramatically.”
How dramatically? According to Justine Handelman, director of federal relations at the Washington-based Blue Cross and Blue Shield Association, the codes will increase on the diagnostic side from 13,000 to 120,000.
The United States is the last industrialized country in the world to implement ICD-10 (it's been in use overseas since the mid-'90s). Currently, the biggest stumbling block is the HIPAA 5010 EDI (electronic data interchange) standard for transactions; because the final HIPAA rule from the Department of Health and Human Services has still not been defined. HIPAA 5010 has the capacity to support the greatly expanded diagnosis and procedure codes. Most agree the timeline for its passage, in the best of cases, is 2008. Once the final rule is approved, however, providers will still need two years to adopt the rule. The earliest ICD-10 would be in use is 2010, though some believe it may take longer.
“The scary thing is we're pushing people to use more and more electronic products,” Rode says. “It would make a lot of sense if new products were being built with the new standard, so they wouldn't have to be retrofitted later. I tell that to vendors whenever I get the chance.”
Though the vendors may be waiting on HIPAA 5010 to move, there are tactics CIOs can use to prepare. “Even before ICD-10 is operational, CIOs can be making their systems more robust,” opines HL7's Huff. That means changing databases to accommodate alphanumeric numbers.
Rode says that the larger the organization and the more history it has, the greater the potential impact. “(Doing) inventory would be a good first step, because not all systems, software and applications carry the code,” he says. “Find out which do.” Rode also believes hospitals ought to be putting something about ICD-10 in their RFIs and RFPs. “I want to know where your company is. I want to know if you're going to be able to convert. I want to know what you envision as the conversion process for your product.”
Bechtel, who also works for Malvern, Pa.-based Siemens, says the company has done preliminary studies on its revenue cycle products. “It's going to be a major overhaul for us. All the software systems that provide workflows of drop-down menus and information on coding will have to be modified to the next level of granularity.”
Training is something a CIO can begin to consider, say many. Several years ago, AHIMA piloted a training session, with surprising results “With only two hours of ICD-10 training,” says Rode, “most of them were coding fairly accurately within a couple of days.”
Coders are not the only groups that will need training. Rode suggests first training managers on the dynamics of ICD-10 if they're out looking for new products. He says the second area of training shouldn't occur more than six months before the changeover.
“We didn't find it that difficult to train, but if you do it sooner than six months, they're going to lose it.” Finally, groups that use the coding on occasion, like utilization review committees or patient care committees, will need some basic training as well.
Handelman believes it's important for CIOs to understand that this is a huge undertaking in terms of upgrades and changes to their entire billing and medical practice systems. “They need to be thinking of the impact, and how many systems this cuts across. Is it my billing, my pay-for-performance, my utilization?” he says. “We have studies that show it's going to cost the industry $14 billion to do this. It should be part of any strategic plan because CIOs need to be planning and budgeting for it.”