On October 1, 2015, ICD-10 took effect in the United States health care system. According to the CDC, ICD-10 stands for the International Classification of Diseases, 10th Revision, and is a medical classification list by the World Health Organization (WHO.) It contains codes for diseases, signs and symptoms, and external causes of injury or diseases.
The American Medical Association (AMA) remarked that the ICD-10 code sets are not a simple update of the ICD-9 code set but have fundamental changes in structure and concepts to make it very different. Concerns with ICD-9 such as the lack of specificity and the inability to add new codes, led to this expansion. The result increased the amount of codes from approximately 13,000 in ICD-9 to approximately 68,000 in ICD-10.
American Health Information Management Association (AHIMA) released there are 2 main reasons that the transition to ICD-10-CM/PCS was necessary, was because of the limitations of the ICD-9-CM code set that the classification system did not reflect current technology and medical treatments and healthcare industry cannot measure the quality of care using ICD-9-CM with new procedures and emerging conditions with an outdated code set.
ICD-10 coding system is being used by the majority of the world, it was time that US caught up. The United States was the only industrialized nation not using ICD-10.
“As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”
Originally set to take effect October 1, 2013, the implementation of ICD-10 was delayed 2 different occasions, and the final implementation date of October 1, 2015 allowed CGH Medical Center’s staff time to prepare.
“We have been preparing and training on this for a very long time,” said Ken Koerner, CGH Director of Hospital Revenue Cycle. “This has included frequent meetings, education, training and knowledge sharing.”
A large committee has met every month for the past three years. Additionally there were subcommittees that also met monthly to work out the details. The revision involved multiple departments: IT, Health Informatics, Case managers, coding staff, scheduling nurses, revenue cycle staff, CDI nurses and some registration staff. Physician education was important too.
CGH coders did web based training where the coders could practice dual coding, meaning they coded a chart in both in ICD-9 and ICD-10. They also had coding simulators that would allow them to code a mock chart and then reveal if they were correct on that coding. The AHIMA professional group had trainings in Chicago, which CGH coders attended. AHIMA also provided webinars that CGH staff participated in.
Many departments of the hospital have unique computer systems and many of these had to be upgraded. Around April of this year, testing began across the whole system to make sure that everything worked. Every week registration staff would put mock accounts into the computer system just like they were real people coming through the system. These would be charged and coded just like a real account to make sure the entire CGH computer systems worked from start to end.
There were lapses in training too due to the governmental delays. The original go live date for ICD-10 was October 1, 2013. The training group did take some time off and waited for further preparations. Once it was certain that there was not going to be a delay this year, everyone worked very hard from April of 2015 until October 1, preparing and testing.
“All the preparation that we did has really paid off. It has been really smooth.” Koerner said. “The national estimate was a 50% increase for coders, on how long it took to code a chart, and we have been well below that with our coders. The only concern is the insurance companies because they had to be ready too. So far we have not seen any issues with the insurance companies. It’s still a wait and see.”
For patients, ICD-10 will allow for the diagnosis of their condition to be more accurately reflected in the coding and billing that is submitted to their health plan. Because ICD-10 has many additional codes that more specifically identify a patient’s condition, the utilization of an unspecified code that doesn’t exactly state the patients’ diagnosis should be greatly reduced. Also, this information is often times shared with national quality and disease tracking institutions, and will enhance the ability of our country to identify and manage disease in a much more specific manner.