ICD-10 gets one-year pushback

Barry Blumenfeld


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.