New medical coding system taxes hospital IT resources

Federal requirement of ICD-10 changeover as much about integration and testing as it is new applications

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At this point, Arges said, the American Hospital Association is watching closely to see how healthcare application vendors, and public and private providers of healthcare plans, are moving forward on ICD-10.

"I've heard from a few Medicaid plans that they're not going to be ready" by the deadline, he said.

The U.S. is one of the last countries to adopt ICD-10, but as such it is also adopting the most thorough revision of the coding system.

For example, ICD-9 has one code for a finger amputation procedure. In contrast, ICD-10 has a code for every finger and every section of every finger, which can then be used by an insurance company to determine what the cost of a procedure should be. For example, a thumb amputation would be more expensive than removing the first section of a pinkie.

The seven-digit alphanumeric ICD-10 codes must be used on all transactions covered under the Health Insurance Portability and Accountability Act (HIPAA), including outpatient claims with dates of service and inpatient claims with dates of discharge on and after Oct. 1, 2013.

Before the ICD-10 codes can be used, however, physicians and others in the healthcare community must start using the new version of HIPAA transaction standards, known as 5010, by Jan. 1, 2012, because the current version, 4010, does not accommodate use of the ICD-10 codes.

The CMS has put its foot down and refused any grace period for ICD-10 implementations. Healthcare providers will not be able to continue to report ICD-9-CM codes for services provided on or after Oct. 1, 2013.

One of the more necessary products being made available to healthcare providers and payers are ICD-10 code translators, which compare ICD-9 to ICD-10 codes and change out the old code with the new.

Kaiser Permanente's Alger said many healthcare providers will be relying on their vendors to provide packaged ICD-10 system upgrades, but even then, implementing those systems, integrating them with existing infrastructure and workflows, and training employees at the same time places a tremendous burden on staff.

"They're going to get new software from multiple vendors in a compact area of time," he said. "I think the test burden and the integration burden is where we'll really stress the smaller players."

For example, surgical scheduling software, healthcare information systems, revenue cycle systems, lab systems, and HL7 clinical interfacing switches will all need to be upgraded and tested at the same time.

"All those things are very likely from different vendors. They now have to get reintegrated, and you have to test that and you have to have enough capacity to run your production world and do a fair amount of testing in your rest world. And you have to be ready to make the cut-over," Alger said.

A lot of the work also includes training employees to write more detailed notes.

"How do you train your surgeon to write a surgical note so that it's at the right level of detail to allow the coder to correctly code that and do the revenue capture?" Alger said. "So there's the human element that's even more complicated in this."

"The key is [whether] those system vendors can deliver products to the provider for testing and process improvements -- things that need to happen based on the changes to the software and the users using it," Whicker said.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at  @lucasmearian or subscribe to Lucas's RSS feed . His e-mail address is

Copyright © 2011 IDG Communications, Inc.

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