Though CMS has indicated it’s planning to push back the October 2013 deadline for the industry’s transition to ICD-10 coding, there’s still numerous training, technology and workflow issues that should be analyzed now to prepare for the inevitable, says Christine Armstrong, the national leader for ICD-10 transformation service at Deloitte.

During an interview at HIMSS12, Armstrong noted that many providers still don’t understand just how deep coding runs through their organizations and how many aspects of operations will depend on staff trained in ICD-10. Staff who negotiate managed care contracts, for example, need to understand how new code sets affect changes in reimbursement and claims flow. Credentialing and marketing also will need to be versed in how the change in coding will impact their work.

In addition, the clinical granularity of ICD-10 means that data from medical devices, and information about radiological contrasts, for example, will have to be pulled to ensure accurate coding. In addition, clinicians from departments such as physical therapy and radiology, as well as case managers, will need to use ICD-10 codes to describe the services they’ve rendered.

“The granularity of ICD-10 requires real significant changes in clinical documentation for the front-line staff, but there needs to be an awareness of how broadly that documentation will be in the future, as well as how broad  training strategies need to be,” Armstrong says.

From an informatics perspective, mapping data between ICD-9 and ICD-10 to ensure data integrity for analytics is going to be a challenge, she says. “Going from one to many codes is going to cause changes in DRG assignments, for example, and there needs to be a deep dive into that issue.” Armstrong also noted that many hospitals are still trying to figure out where cross mapping is going to reside in their I.T. infrastructures. Many are building terminology servers that all applications can feed into, so there’s one centralized “source of truth” for the organization instead of having mapping done in different corners of the infrastructure, she says.  


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