Charlene Webber-Schuss, chief information officer at Community Hospital on California’s Monterey Peninsula, faces two major problems in negotiating the gargantuan shift to ICD-10 coding, now less than a year away.
First, she must get the in-house coders at her 235-bed not-for-profit hospital trained before the Oct. 1, 2014 transition date.
Then she must figure out how to train the large majority of the hospital’s physicians, who are independent community-based practitioners, to capture what hospitals and physicians do and translate that information into discrete diagnoses, procedures and billable events. So far, the hospital has spent eight months and $900,000 in IT resources on ICD-10 readiness.
“We’re concerned about a lot of the community practices,” Webber-Schuss said. If the doctors’ documentation is inadequate, “we (and they) will suffer lost revenue.”
It’s a drama that’s playing out in more than 5,000 hospitals and tens of thousands of physician practices across the country. The twice-postponed switch to the coding system officially known as the International Classification of Diseases and Related Health Problems, 10th Revision, will usher in two far more complex sets of codes, compared with the code sets that have been in place since the 1970s.
For healthcare providers, there are about 68,000 diagnostic codes under the new ICD-10-CM (clinical modification) codes, five times more than are in use today under ICD-9-CM. An even more complex matrix of 87,000 new codes for hospital-based procedures awaits in the ICD-10-PCS (procedural coding system), 29 times more codes than are used in ICD-9-PCS.
Supporters say ICD-10 will allow providers to keep better track of patient care and aggregate data to perform quality-improvement analysis. It should also give hospital and physician leaders sharper tools for analyzing the impact of new procedures and managing population health. They’ll also be better able to track individual practices and identify inappropriate practice variation.
But the costs of the conversion are major issues for providers and their IT departments, which are already under pressure to improve performance on many fronts. They have to meet Stage 2 meaningful-use standards of interoperability for electronic health records. Also, they have to generate numerous reports that will help quality and safety officials improve performance and avoid government penalties.
Then there are the possible post-adoption financial consequences of the more complex ICD-10 coding system. Some hospital officials and physician leaders fear a decline in coder productivity, which could result in revenue losses from bad documentation, delays in inputting data and rejected claims because of improper coding or unproven IT systems.
“There’s no question it’s a lot of work,” said veteran physician informaticist Dr. Christopher Chute, who founded the division of biomedical informatics at Mayo Clinic. Last year, Chute joined four other healthcare IT heavyweights in the policy journal Health Affairs in calling for a one-year delay in ICD-10, saying the conversion will be “expensive, arduous, disruptive, and of limited direct clinical benefit.” He said it will take several years of data collection before ICD-10 data will prove its worth in secondary uses for quality improvement and comparative effectiveness research.
