Nearly a quarter-century in the making, the ICD-10 coding system is barely one month into implementation in the United States, and – at least in its early stages – Memphis-area medical professionals report a fairly smooth transition to the new classification process.
This is in large part due to years of training to prepare medical personnel for the deluge of new codes, and to time-saving computer programs that help demystify and simplify the process.
“Our software converts the ICD-9 codes to the new ICD-10 codes, and there are prompts and pop-up questions that lead us through every facet of a patient’s diagnosis,” said Dr. Frederick Pelz of Memphis Internal Medicine. “All in all it’s been pretty easy, but we’re just in the beginning stages. We’ll have to see how it goes after we’ve been using this for a while.”
Bill Griffin, vice president of corporate finance at Baptist Memorial Health Care Corporation, agreed.
“It’s been 23 years since we first heard about the transition to ICD-10 and started getting ready for it, and we’ve had a massive education program for hundreds of our doctors, coders and hospital employees,” Griffin said. “We’ve offered hundreds of hours of training and spent millions of dollars to prepare for this because we realized the magnitude of the process and we knew we had to get ready for it.”
And yet Griffin acknowledged that it would be premature to declare the implementation of ICD-10 codes an unqualified success.
“It’s too early to offer a definitive opinion, but at this point it reminds me of the hysteria surrounding Y2K, when people thought there would be a massive worldwide disruption in computer services when we ushered in the year 2000,” Griffin said. “That turned out to be a non-event, and other than a few minor bumps here and there, and from what I’ve seen at this point, that sums up the initial transition to ICD-10.”
But while implementation of the new coding system has mostly been without incident, many local healthcare practitioners are anticipating a different scenario several months from now, when billing practices begin to reflect how accurately – or not – the tens of thousands of new codes are being utilized.
“So far, so good, but it’s early. We won’t really know for a while, will we?” said Dr. Jerome Thompson, a pediatric ENT physician at Le Bonheur Children’s Hospital and chairman of the Department of Otolaryngology – Head and Neck Surgery at the University of Tennessee Health Science Center. “There may be problems with reimbursement from different insurance companies, with one company reimbursing for one code while another company doesn’t. When this system rolled out in Canada, initially there was a 50 percent reduction in reimbursements because of the ways different insurance companies interpreted the codes. We’re going to be watching very closely to see how it plays out here.”
Meg McGill, corporate director for health information management at Methodist Healthcare, echoed those sentiments. Methodist spent about three years providing training for its physicians, medical personnel and coders to prepare for the big switch, and thus far the process has gone off without a hitch.
“I’m glad to say that it’s gone well, amazingly well, since we made the transition,” McGill said. “We’ve had many groups working simultaneously to prepare everyone for this because we were determined to be ready for it when it finally happened.”
Added Donna Hunt, corporate coding director for Methodist, “We were very methodical going through all the terminology, and we offered personal training, consultations and online courses. We started about three years ago, and that gave us the time necessary to address any situations and ensure that all our personnel felt confident in using the new system.”
The ICD-10 coding system that went effect Oct. 1 is an extensive list of more than 55,000 new codes that often pose dizzying degrees of specificity.
For example, farm workers have an expanded list to choose from when suffering from on-the-job injuries, such as code W55.29XA: Other contact with cow, subsequent encounter. And then there’s this animal kingdom reference point, W56.22XA: Struck by orca, initial encounter.
The detail in the new codes provides greater flexibility in diagnosing conditions, medical professionals say, and offer better methods for tracking recovery and treatment options.
“There are now nearly 20 codes that may apply to a patient who has eaten a toxic mushroom,” Griffin said. “And if you’ve eaten a bad mushroom, you need to know what kind and what to do about it. It’s all about specificity.”
But while the specificity of the new coding system may help to more narrowly define diagnoses, the codes aren’t as useful in clinical research.
Dr. Dan Martin, a gynecologist and reproductive surgeon with UT Regional One Physicians, said a very real problem with the new codes is that they aren’t, well, new.
“The main inadequacy with ICD-10 is that the codes are 23 years old," he said. "That’s how long they’ve been around, and as far as being useful as a clinical research tool, the codes just don’t do that job very well. They may be useful in other practice areas, but by nature of what I do, by the time these codes come out they’re already outdated. Imagine all of a sudden implementing technology that’s two decades old and using it as a tool for your research. It’s just not that useful for research purposes.”
But with more than 70,000 diagnostic codes and more than 72,000 procedure codes now just a mouse click away, physicians have an extraordinary range of conditions from which to choose.
“One of my favorites is code R46.1, which refers to ‘Bizarre Personal Appearance.’ I think there are probably a lot of applications for that one, depending on where you practice and the patients you treat,” Griffin said. “Another favorite is V95.41XA, which refers to ‘Spacecraft crash injuring occupant, initial encounter.’ It’s all about specificity, and that code illustrates that point pretty well.”
Of course, doctors allow that while the ICD-10 system offers thousands of minutely detailed codes to consider, occasionally there are those that probably aren’t specific enough, such as code Z63.1: Problems with the in-laws.
Or this code, which perhaps serves as the antithesis of specificity: T63 – Unspecified event, undetermined intent.