ICD-10 gets one-year pushback

By Erin McCann
10:33 AM


Hospitals, providers reveal opinions of new coding system

WASHINGTON  -  An Aug. 24 decision by the Department of Health and Human Services to delay the ICD-10 compliance date one year has some providers in a haze, where they're left deciphering the often-encrypted implications of the pushback.  

Many providers describe this haze as more of mist, a light, altogether positive decision that may offer providers more time to get their house in order. Others, however, describe it as more miasmic, a slow asphyxiation of provider finances and resources. 

Morse codes, bar codes, the Da Vinci code, even the code of ethics are child's play in comparison to ICD-10, which is a comprehensive catalog of 155,000 diagnosis and procedure codes, up from approximately 16,000 in the 30-year-old ICD-9.  

That's nearly a tenfold increase in the number of codes, but Barry Blumenfeld, MD, CIO of MaineHealth, with eight hospitals across the state, says: "It's not the number." 

The real problem, he says, is twofold. First, "These are codes that are really more geared toward classification for billing purposes than they are toward diagnoses. So from a clinician's perspective, they don't really add that much." What the codes do add, however, is "a lot of complexity, without adding a lot of information value," adds Blumenfeld. 

Moreover, Blumenfeld says he couldn't fathom how officials thought up some of the codes. He cites one code, in particular, that downright baffled him  -  V91.07XA, a diagnosis code indicating an initial encounter burn due to water-skis being on fire. 

The added complexity  -  and often baffling nature  -  of the codes stand as the primary reason Maine Medical Center utilizes a third-party tool that uses "physician-friendly terminologies" to better use ICD-10. Using this Intelligent Medical Objects tool, which will be integrated into the MaineHealth's new Epic electronic medical record (EMR) system, Blumenfeld says, "it's much easier for the physicians to choose their codes using that physician-friendly terminology, and then have it mapped to the ICD-10s, then it would be to just use the raw ICD-10s." 

Other individuals, however, view ICD-10's generous uptick in codes and complexity in a more positive light. Robin Stults, vice president of health information management at the 835-bed Parkland Memorial Hospital in Dallas, says the added specificity and complexity of the coding system will ultimately yield better data, and that should be a main objective for hospitals.

"The information you receive will be a lot more robust. I think there will be a higher level of accuracy and definition," Stults says. 

The ICD-10-PCS (Procedure Coding System) contains approximately 87,000 diagnoses codes, up from ICD-9's 13,000 codes. 

The ICD-10-CM (Clinical Modification) contains approximately 68,000 diagnoses codes, up from ICD-9's 4,000 codes. 

CMS offers a comparative code sample, comparing an ICD-9 diagnostic code with an ICD-10 diagnostic code: 

ICD-9-CM diagnosis code: 813.15, open fracture of head of radius

ICD-10-CM diagnosis code: S52123C, Displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC. 

Effects of delay

Blumenfeld is onboard with the compliance delay. With MaineHealth rolling out an Epic electronic medical record system at its eight hospitals and all physician practices, the extended deadline provides a bit of a breather. 

He adds, however that he understands other hospitals may be more disenchanted with the delay, as they were making preparations for an Oct. 2013 deadline. 

"If everybody had gotten all dressed up for the party and were ready to go, and then all of sudden found it was put off, it might entail more expense just re-sequencing everything," Blumenfeld says. 

Stults  -  along with numerous hospital administrators nationwide  -  also support the delay, as it means additional time to ensure that staff is adequately trained for the transition. 

"In the area of clinical documentation and with all of the progress that's been made with electronic medical records, there's a lot of work to do to really enhance the content enough to really meet the demands of what ICD-10 is going to require," she says. "Another year for me is a greater opportunity to train or remediate staff."

Although providers now have another year to master the coding system, some groups are decrying the delay as an increased financial burden to hospitals. 

The American Health Information Management Association (AHIMA)  - a group that represents 64,000 health information management professionals worldwide  -  for example, opposed the delay from the very beginning. 

Melanie Endicott, director, HIM Solutions at AHIMA, cited increased costs of providing one more year of additional training and education for coders and providers alike as a downside to the ICD-10 delay. "We feel that there were a lot of healthcare entities that were ready for Oct. 1, 2013, and delaying it a year is just causing increased costs to them," Endicott said.

In the Regulatory Impact Analysis (RIA) of this final rule, HHS officials estimated a cost avoidance of $3.6 billion to nearly $8 billion, just from avoiding the costs related to a large number of healthcare providers being unprepared for ICD-10. However, the RIA also found the delay would cost both commercial and government health organizations an additional 10-to-30 percent more than the groups had budgeted. 

For some hospitals, however, the cost is not the problem. 

Both Stults and Blumenfeld don't see the delay as adding additional costs. 

If Blumenfeld could change ICD-10, it wouldn't be the delay; it would be the coding system itself. 

"I would not have made it quite as hierarchical. I would have unique identifiers instead of hierarchical terminologies. I would have tried to integrate it in a way that made more clinical sense." He cited SNOWMED CT as his preferred medical coding system, citing that the system is easier to use, clinician-based and more accurate with adding that thick layer of complexity he believes ICD-10 has.