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The Catalyst

New medical-code sets, physician training planned

By Cindy Abole
Public Relations

Hospitals and health care industry staff are bracing for a change in the world of diagnostic coding.
By Oct. 1, 2014, all U.S. health care providers must adopt the newest medical procedure coding structure, ICD-10-CM/PCS, to accurately report inpatient procedures and activity at health care centers and in-patient hospital settings.

The change is a significant upgrade from the outdated ICD-9 coding structure, increasing the number of medical codes to 68,000, which allows for more detail and flexibility. This national mandate also aligns the United States with Canada, France, Germany, Australia, China and other countries that already use these detailed code sets to classify morbidity and mortality data and track health statistics. In the U.S., ICD coding is used for insurance claim reimbursement, resource allocation and data management.

To prepare for this conversion, the medical center launched its own journey to synch the ICD-10 conversion with the new Epic electronic medical record system. The first step in the actual implementation of the use of ICD-10 terminology will begin in outpatient and emergency room settings in February 2014. The plan will be for coders to utilize dual coding for both ICD-9 and ICD-10 until go-live for inpatient, scheduled for next July. By October 2014 all clinical areas will use and select from the ICD-10 CM (diagnosis) codes and ICD-10 PCS (procedure) codes for their documentation. 

Comparing ICD-9 and ICD-10

ICD-9 (13,000 codes)

  • Three to five characters in length
  • First digit may be alpha or numeric
  • Limited space for new codes
  • Difficult to analyze

ICD-10 (68,000 codes)

  • Three to seven characters in length
  • Digit 1 is alpha, digit 2 and 3 are numeric, digit 4 through 7 are alpha or numeric
  • Flexible for adding new codes
  • Very specific

ICD-10 CM is the tenth version of the International Statistical Classification of Diseases and the National Center of Health Statistics under the World Health Organization. ICD-10 PCS was developed by the Centers for Medicare & Medicaid Services. What’s new about the ICD-10 codes is that they are more specific, according to Sue Pletcher, Health Information Services director, who represented her area on the ICD-10 implementation executive oversight committee.

For example, congestive heart failure, a condition when the heart fails to pump blood properly through the entire organ, is coded as 428.0 under the old ICD-9 code and requires coders to use 15 codes (ICD-10) to describe heart failure in the left ventricle (428.1), systolic heart failure (428.2), diastolic heart failure (428.3,) or a combined systolic and diastolic (428.4).

In ICD-10, code descriptions are more specific such as heart failure following surgery, heart failure related to hypertension, heart failure and hypertension with chronic kidney disease, heart failure during obstetric surgery or rheumatic heart failure.

During project planning, teams reviewed the hospital’s health information systems status, consulted with Epic electronic health record system managers, assessed documentation practices and policies, reviewed and developed coder, staff and physician training, and numerous other activities.

Phyllis J. “PJ” Floyd, R.N., Health Information Services Clinical Documentation Integrity & Abstraction director, a co-chair with the ICD-10 Clinical Integration Subcommittee, leads physician training and the preparation of physician support staff, operations staff, coders, department schedulers and other groups. Floyd and her team have been involved since the first day of planning from multiple perspectives. For the training piece, Floyd’s team prepared materials to accommodate all types of learning styles. They also prepared an array of tools — pocket cards, instruction materials, tip sheets, eLearning technologies as well as classroom instruction — to assist physicians and coders. To ensure a successful rollout, leadership has hired Deloitte Consulting to conduct assessments and guide the transition.

“Adjusting to these new code sets will require more time and patience from coders, physicians and trainers. We’re committed to helping during this transition period and offering solutions that will increase specificity,” said Floyd.

According to Floyd, the launch for physician training with ICD-10 began in January with an orientation session and brief review with the surgery department including the vascular surgery division.

Bruce M. Elliott, M.D., professor and chief of the Division of Vascular Surgery, sees changes and consequences with the ICD–10 coding updates. Elliott, who is a member of MUSC Physicians’ executive committee, sits on the hospital’s payment policy committee, and has followed the hospital’s progress regarding physician and staff training.

Elliott’s area is slated to be among the first surgical departments to complete physician training.

“It’s imperative that our physicians and staff be successful to learn this new coding system both quickly and accurately. It’s also essential that the right tools and support plans are in place for this transition
to be successful.”

MUSC is among a handful of institutions taking a proactive approach to the new code set conversion with communications, multiple levels of training and departmental support.

According to Elliott, the medical center was tested in 2012 with the first launch of the Epic electronic medical record system in the ambulatory and emergency departments.

“Although Epic’s implementation process was well organized and training was coordinated, roll out in specific areas was complicated and disruptive. With a project of this scope and size, it’s realistic to expect some disruptions throughout this conversion period,” Elliott said.

The ICD-10 readiness is being led by hospital leadership and guided by an ICD-10 Steering Committee, compliance team members and other planners to assess the needs of departments and medical specialties, schedule training for physicians and staff, create support tools and conduct field testing to support the full implementation.

June 26, 2013
 
 
 

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