ICD-10: The ‘800-pound Gorilla’
"ICD-10 is the 800-pound gorilla in the room," said Lisa Miller, CIO of Xeohealth and co-chair of the WEDI workgroup assigned to the ICD transition. Although the deadline for implementation of the ICD-10 code set is not until Oct. 2013, the industry needs to be gearing up now, Miller urged during a presentation at the HIMSS 2010 Conference in Atlanta.
"ICD-10 is the 800-pound gorilla in the room," said Lisa Miller, CIO of Xeohealth and co-chair of the WEDI workgroup assigned to the ICD transition. Although the deadline for implementation of the ICD-10 code set is not until Oct. 2013, the industry needs to be gearing up now, Miller urged during a presentation at the HIMSS 2010 Conference in Atlanta.
Miller cautioned attendees to not underestimate the difficulty of transitioning to the new code set, which greatly expands the number of procedure and diagnosis codes under ICD-9. The new set will move to 87,000 procedure codes, up from 11,000 in current use. In addition, ICD-10 requires a much higher level of granularity around procedures, including such details as whether a surgery was performed on the right or left side of the patient.
Because of that granularity, Miller said the new code set will result in fewer miscoded and rejected claims since providers will be able to better document what they did. On the other hand, the sheer bulk of new codes, plus the impact on current information systems and business processes, means the conversion will be difficult at best. Miller presented a chart compiled by WEDI which demonstrates the vast reach of ICD-10. "It touches the fabric of the health care world, not just traditional providers and payers," she said. For example, pharmacies, schools, and medical suppliers all depend on diagnosis and procedure codes, and ensuring that these organizations are on the same platform is critical.
Miller's co-presenter, Andrea Danes, senior principal at CSG Government Solutions, noted that the industry is distracted by the federal push toward EHR adoption and data exchange. She likened this period to the pre-implementation period of the HIPAA transaction standards, for which the industry was unprepared. Danes advised organizations to designate an executive sponsor over the ICD-10 transition effort and not assume that a quick "cross-walk" approach will suffice. "The codes, nomenclature, and information carried in them are completely different," she said. "There is no way to cross-walk directly."
--Gary Baldwin
Miller cautioned attendees to not underestimate the difficulty of transitioning to the new code set, which greatly expands the number of procedure and diagnosis codes under ICD-9. The new set will move to 87,000 procedure codes, up from 11,000 in current use. In addition, ICD-10 requires a much higher level of granularity around procedures, including such details as whether a surgery was performed on the right or left side of the patient.
Because of that granularity, Miller said the new code set will result in fewer miscoded and rejected claims since providers will be able to better document what they did. On the other hand, the sheer bulk of new codes, plus the impact on current information systems and business processes, means the conversion will be difficult at best. Miller presented a chart compiled by WEDI which demonstrates the vast reach of ICD-10. "It touches the fabric of the health care world, not just traditional providers and payers," she said. For example, pharmacies, schools, and medical suppliers all depend on diagnosis and procedure codes, and ensuring that these organizations are on the same platform is critical.
Miller's co-presenter, Andrea Danes, senior principal at CSG Government Solutions, noted that the industry is distracted by the federal push toward EHR adoption and data exchange. She likened this period to the pre-implementation period of the HIPAA transaction standards, for which the industry was unprepared. Danes advised organizations to designate an executive sponsor over the ICD-10 transition effort and not assume that a quick "cross-walk" approach will suffice. "The codes, nomenclature, and information carried in them are completely different," she said. "There is no way to cross-walk directly."
--Gary Baldwin
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