Unlike many health systems, Geisinger Health System is ahead of the curve on ICD-10. Intending to meet the original Oct. 2013 compliance deadline, Geisinger completed an impact assessment in the spring of 2011. And now it’s crafting a system remediation timeline. Susan Trewhella, associate vice president, revenue management, at the Danville, Pa.-based system described the effort at HIMSS13 in New Orleans. “We asked where ICD-9 codes are used,” she said. “It’s unbelievable what we found.”

Geisinger identified some 80 discrete information systems that used ICD-9 codes and would require remediation. These spanned a wide variety of systems, including scheduling and registration, imaging, charge capture and even the patient portal. Trewhella said Geisinger has dedicated I.T. staff who oversee vendor readiness.  “We need to see a plan from the vendor, otherwise they may not be our vendor,” she said.

No vendor has to date declared they would not be ready for ICD-10, she noted, but several have yet to produce a remediation plan or timeline. That suggests to her that the vendor won’t make it, and the health system will have to figure out an alternative. Geisinger has a governance plan in place, which is driven at the top by a senior level executive steering committee with a number of other workgroups reporting up to it. At some point, Geisinger will shift into a dual-coding mode to facilitate testing of affected systems and identify where additional training may be needed.

To assist, the health system hired PricewaterhouseCoopers. PWC Partner John Dugan advised that health systems not be overwhelmed by the apparent enormity of the task of using tens of thousands of new codes. Instead, he said, “Know your numbers,” meaning focus on those ICD-9 codes which drive the majority of revenue and begin there. “Less than 20 percent of your doctors may drive 90 percent of your revenue,” he noted.



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