ICD-10 involves an ‘enormous amount of complexity’

By John Andrews
02:55 PM

As if they weren’t preoccupied enough with electronic health records, meaningful use and interoperability, hospital IT staff must also contend with the upcoming switch from ICD-9 to ICD-10 coding in October 2013. And while that date may seem well off in the distance, there’s no room for delay at this point, vendors say.
Mike Nolte, vice president and general manager for GE Healthcare IT in Boston, says the coding switchover involves “an enormous amount of complexity” that requires methodical adherence to preparation, planning and logistics. The complexity encompasses several areas, from changing the language format to managing the connection point to temporarily running ICD-9 and -10 at the same time. Moreover, he says, providers with custom legacy systems will have to consider major replacements.
“If they have a homegrown revenue cycle platform, there will be a lot of issues,” he said. “They will probably have to rebuild a good chunk of infrastructure that supports it.”
Nolte equates the mapping of existing data structures in ICD-9 to ICD-10 with “switching from an English-based system to Chinese.”
GE has been working to ensure that providers will be ready in plenty of time for the ICD-10 “flip of the switch,” set for Oct. 1, 2013, and that the HIPAA 5010 data transmission platform that supports it will be in place next year, Nolte said. An update to GE’s version 4.3 software, due to be released this year, will include the functionality for running both ICD-9 and ICD-10 together.
“There will be a period where they will have to live in both worlds for a while, so the software upgrade will allow them to do that,” he said.
‘Bigger than Y2K’
Debbie Coates, director of San Diego-based Sharp HealthCare’s finance information systems, says the ICD-10 project is “bigger than Y2K due to its complexity and because it touches everyone in the enterprise in one way or another.” The coding change affects policies, procedures, workflows, data interfaces and, overall, some 50 systems at Sharp, she said.
“Everything needs to be looked at, evaluated and updated,” she said. “And the list of what needs to be done continues to grow. It is a very, very large undertaking. I almost feel like we need two more years.”
Even so, Coates said the organization is “in a good position” because they have laid the groundwork for the transition, including assembling a core steering committee and various work groups to propel the initiative forward. One of the main challenges of the coding project, she said, “is working with trading partners to figure out when they will be ready and the orchestration of that.” That includes payers, clearinghouses and other providers.
“Once they are ready, we will have to document who will receive and send, which pieces and parts they can do, the ‘inbound versus outbound’ issue and who we can work with,” Coates said. “The payer component is a really big effort to track.”
Overall, the ICD-10 conversion is “one of the biggest financial issues” Coates and her staff have faced, with five people dedicated to working full-time on the electronic data interchange and 5010 pieces.
“This won’t go away – you need to look at your contracts, identify key performance indicators and start dashboarding to see current problems in all areas, including utilization, risk management, pay-for-performance reporting and DRGs,” she said. “All of it is impacted.”
‘Ticking time bomb’
George Schwend, president and CEO of Denver-based Health Language, calls ICD-10 “an intense, ticking time bomb and everyone needs to get ready for it. If they aren’t, when the clock strikes 12 on Oct. 1, 2013, they won’t get paid.” Health Language has been working on vocabulary and coding standards for more than 10 years and has established a reputation for helping to standardize the healthcare industry’s diverse terminology.
The biggest challenge is the shift that stratifies classifications from 15,000 codes in ICD-9 to 110,000 codes in ICD-10, he said. Amazingly, there are coders who “know the 15,000 practically by heart because they use the same 5,000 every day,” Schwend said, adding “it will be very different when it expands to 110,000.”
Tori Sullivan, manager for Capgemini Government Solutions in Washington, saidthe scope of this change is so pervasive, it’s intimidating to many providers.
“This isn’t just a coding update, it is truly an organizational change,” said Sullivan, who published the book ICD-10 for Hospitals in 2009 and leads the HIMSS ICD-10 Task Force.