Coding On Steroids

 

The AHIMA ICD-10 Summit, which wrapped up earlier this week, was like a homecoming for me. I got my start in health writing at the national organization of coders and health information managers back in the early 90s. Back then, the electronic health record was called the computer-based patient record, and the idea of health information management--previously called “medical records”--was in its infancy. AHIMA never became the national forcing steering the way to the digital chart like its leaders once envisioned. But its members still do the heavy lifting of documentation management, quality assurance, and payer compliance.

 The ICD-10 event drew a full house—some 400 or so, AHIMA staffers said, with a sprinkling of vendors and payers. This transition to ICD-10, affectionately referred to as simply “10” by several speakers, will challenge this industry unlike any other. As one speaker from Blue Cross pointed out, the new system touches all departments except “food services and housekeeping.” For coders, ICD-10 represents the challenge, if not the opportunity, of a lifetime. They are a group well-traveled in the minutiae of clinical record-keeping and the equally arcane payer rules surrounding them. Under 10, a quantum leap in the sheer number of new codes awaits. Moreover, the new nomenclature represents a very different way of thinking about clinical documentation than ICD-9 required.

Presenter Margaret Skurka humored the crowd with her down-to-earth explanations of such topics and asides about getting physicians in line with the abundance of new codes, which will enable a type of meticulous documentation impossible with ICD-9. Angioplasty codes balloon from 1 code to over 1100 for example, noted Skurka, the director of the HIM program at Indiana University Northwest.

The transition’s partly an IT issue, and every speaker I heard made the same point: providers need to begin their system inventories now and identify where ICD-9 is used and how. Many of the systems are obvious, like billing and clinical documentation. Others are less so. These include the so-called “rogue databases,” those prolific instances of departments maintaining their own clinical databases on spreadsheets or other programs that track projects, performance, or any number of activities.

Speaker Mary Beth Haugen, a coder turned IT consultant, pointed out that many of those modest databases often play critical roles in grant projects. She also cautioned the audience to inventory its current array of vendors and clarify, or at least try to, how many systems would require upgrades and how many will simply be sunset as vendors shift to a new ICD-10-driven package. This question of upgrade or replace is a big one, with potentially large financial implications for the industry. While some CIOs I have talked to assume most of their larger systems will be transitioned to ICD-10 as a part of current contractual terms, Haugen pointedly remarked: “I can’t imagine it will be free.”

During the event, there were often protracted silences on the part of the audience. You could all but hear the wheels turning in the coders’ heads. This is, after all, a group whose Summit program booklet included a place to write down notes—differentiated as “key messages,” “key takeaways,” and “other observations.” Coders thrive on such delineations. So when the conversation shifted to the “Gustilo Classification of Fractures,” an obscure naming system embedded in ICD-10 that Skurka dryly described with a mix of admiration and intellectual irony, interest was piqued. Confessing she had never heard of the system, the coding educator described how she texted a friend married to an ortho doc, to see if the physician had. His answer: “Why do you ask?”

Skurka’s recounting of the story brought down the house in laughter. It was a moment of levity for a group facing a very serious challenge.