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Fear Not the Switch from ICD-9 to ICD-10


Some people adopt a “Chicken Little” mentality when faced with making big changes, says Kathy DeVault, RHIS, CCS, CCS-P, manager of professional practice resources for the American Health Information Management Association (AHIMA). The change she’s referring to is the switch from the current version of the International Statistical Classification of Diseases coding system (ICD-9-CM) to the ICD-10-CM/ICD-10-PCS, which must be effective in hospitals by Oct. 1, 2013.

Hospitalist Jeffrey Farber, MD, assistant professor of geriatrics and palliative medicine and director of the Mobile ACE Service at Mount Sinai Hospital in New York City, also is director of the Clinical Documentation Improvement Department at Mount Sinai. He already is intimately involved with his hospital’s ICD-10 implementation process.

“For hospitals, this is a very big deal,” Dr. Farber says, “because it affects not just the coding department, but quality, compliance, and public reporting. On the physician side, there will be major changes in clinical documentation. Hospitalists who also do procedures, even bedside procedures, need to understand what is required.”

Why the Change?

Surprisingly, the U.S. is the last industrialized country in the world to upgrade to the ICD-10 system. The older system, in use since 1979, does not reflect three decades of change in medicine. “ICD-10 allows for a much better capture of specific types of treated diagnoses, provided services, and performed procedures,” Dr. Farber says, “and allows a lot more room to grow for the future.”

At first glance, the sheer numbers of new codes appear daunting. For example, procedures codes will increase from the current 4,000 to approximately 87,000. Hospitalists who perform procedures must include more description in their notes, including devices used and anatomical location of device placement.

Even if you’re not doing procedures, you may not relish the prospect of going from the current 14,000 ICD-9-CM diagnoses codes to nearly 70,000 ICD-10 codes. But, Dr. Farber explains, many of the increased descriptors have to do with laterality, which previously was not captured. To note a diagnosis of stroke, you will have to write not only whether it occurred in the posterior cerebral blood vessel, but also whether it was right or left posterior cerebral.

Listen to Kathy DeVault describe forthcoming documentation changes.

Ultimately, he believes, this type of specificity will relieve a burden on hospitalists, because providing more specific documentation should reduce queries from coders.

Common-Sense Approach

The October 2013 deadline allows plenty of time for physician training, says DeVault, who has been training coders through AHIMA’s ICD-10 Academy the past two years. Breaking the process down into manageable steps is helpful, she says.

On the physician side, there will be major changes in clinical documentation. Hospitalists who also do procedures, even bedside procedures, need to understand what is required..

—Jeffrey Farber, MD, assistant professor, geriatrics and palliative medicine, director, Clinical Documentation Improvement Department, Mount Sinai Hospital, New York City

“Look at your group’s most common, acute conditions, for example, and ask, ‘What is missing in the documentation?’ Especially if you can make bridges with your health information management (HIM) department, you will find that there are many opportunities to teach each other,” she says.

Hospitalists can do several things to ready their group for ICD-10, Dr. Farber says. Take a proactive stance, he advises, and select your group’s top 25 diagnoses. Then work with coding staff to map them from ICD-9 to ICD-10. On a macro level, understand what your hospital’s timeline is for the change. DeVault says that HIM departments are eager to collaborate with physician champions.

The good news: The sky isn’t really falling, according to DeVault. And the change to ICD-10 actually offers lots of opportunities for collaborations between hospitalists and health information departments.

Gretchen Henkel is a freelance writer based in California.

Watch Out for GEMs

Physicians often are encouraged to use general equivalence maps (GEMs) to acquaint themselves with the differences between coding sets. Relying solely on GEMs, however, is not a good idea for the long term, DeVault cautions. “GEMs are meant to serve as a transition tool but are not designed to code from,” she says. “It’s imperative that coders—and providers—actually learn the new system and that they not rely on GEMs for coding.”—GH

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