Health care industry readies for massive medical code update

ICD-10 — five little characters and a hyphen that are causing a whole host of headaches for medical providers and health systems across the country.

Come October — after several years of delays — hospitals, medical providers, insurers and medical coders will have to have transitioned to an updated version of the International Classification of Diseases (ICD) moving from the ICD-9 code sets to ICD-10.

These codes help physicians and hospitals communicate with insurers, allowing providers to explain services and justify claims.

ICD-9 has been in place for more than 30 years, and health industry experts say it is out-of date. The new codes will allow for greater specificity of reporting, which will help hospitals and insurers collect better data and pinpoint areas in which improvement is needed, including readmission rates.

'We're running out of space to expand code sets,' said Kim Vegter, a coding educator at MediRevv. The revenue cycle management company based in Coralville offers coding and billing services, working with health systems and providers across the country.

'For instance a few years back, when H1N1 (swine flu) was popping up, the codes we had didn't clearly define H1N1. We need room to add codes so we can properly document,' she said.

Because of this, Vegter said those in the medical industry may use unspecified codes, which don't provide specific details and could cause problems when it comes to justifying a claim to an insurer.

"The more specific we can be as to why, the better chance those services will get paid by the insurance company, which needs as much information as possible.'

- Kim Vegter

MediRevv coding educator

The transition from ICD-9 to ICD-10 will greatly expand the number of codes available, jumping from 13,000 to about 70,000. The new code set will allow more information to be conveyed as well as include codes that are a combination of diagnoses and symptoms — so fewer codes overall are needed to fully describe a condition.

ICD-10 also allows providers to designate between right and left, such as reporting an injury to the left arm or left eye.

'The more specific we can be as to why, the better chance those services will get paid by the insurance company, which needs as much information as possible,' Vegter said.

Implementation costly, time consuming

But implementing the new software, educating providers and medical coders on the updated codes, and readying IT systems for the Oct. 1 deadline is a huge and costly undertaking.

Renee Rasmussen, vice president of revenue cycles for Des Moines-based UnityPoint Health estimates the update will cost the health system $15 million. UnityPoint Health has 32 hospitals and 280 clinics across Iowa, Wisconsin and Illinois, including St. Luke's Hospital in Cedar Rapids.

Since the initial federal regulation came down in 2009, the health system has been working to train its more than 900 doctors and specialists through web-based education modules, smartphone and tablet apps, and videos. It's also been working to train its medical coding department, going as far as having leadership certified in ICD-10.

Leaders at Mercy Medical Center in Cedar Rapids also have been working to get hundreds of employees trained and ready for the transition.

Shawn Steffen, the hospital's senior director of revenue cycle, said Mercy offered a video training tool to physicians and nursing staff as well as its coders, so they could complete the training on their time. Most doctors had to complete two to four hours of training, which was tailored for their specialties, while the hospital's coding department underwent hundreds of hours.

Mercy also had to work with each of its business vendors — such as software companies that supply products and services — to make certain systems are properly updated and will comply with the law come October.

Steffen wasn't sure of the total number of vendors but said it was more than 10.

Dr. Donald Hilliard, Mercy's chief medical information officer, said doctors have mixed feelings on the update.

'Some are very eager to go ahead with the change and see the advantages,' he said.

But others who don't fully appreciate the value in making the leap are more resistant.

The ICD-10 update also comes at a time when physicians and hospitals are under pressures to improve quality while reducing costs and implement electronic medical records.

Delays

Both Mercy and UnityPoint Health are now in the testing phase, looking for problem areas and working with payers — including Medicare, Medicaid and Wellmark Blue Cross and Blue Shield — to make sure claims can be submitted properly.

At the end of February, the Centers for Medicare and Medicaid Services (CMS) announced that 81 percent of test claims it received were accepted during its first testing round. There's still a second round of Medicare testing to be completed as well as a round of Medicaid testing.

Despite all the preparations, the health care industry is bracing itself for additional delays. The federal government, which originally set a 2013 deadline, delayed the upgrade due to concerns from CMS and health care systems across the country.

The delays have been frustrating for hospitals, which say they've been getting ready for this update since 2009.

Those delays 'gave people a pause,' Rasmussen said, adding it slowed implementation on vendors and payers' ends. 'We wouldn't have to do as much testing now if we could have done it six months ago.'

Steffen agreed.

'We're ready, we've been ready,' he said. 'It's hard to gear up and the gear back down then gear up and then gear back down again.'

He added that some facilities are discussing to go live with the update in October, no matter what the government chooses.

'We're having the same conversations,' he said. 'It can really drain on the system after a while.'

There's a code for what?

Among ICD-10's more than 70,000 codes for diseases and injuries are some for not-so-typical ailments:

W56.22xA — Struck by orca, initial encounter

V91.30xA — Hit or struck by falling object due to accident on merchant ship, initial encounter

X52 — Prolonged stay in weightless environment

V96.00xS — Unspecified balloon accident injuring occupant, sequel

W61.62 — Struck by duck, sequel

V95.42xA — Forced landing of spacecraft injuring occupant, initial encounter

Z73.4 — Inadequate social skills, not elsewhere classified

V91.07xD — Burn due to water-skis on fire, subsequent encounter

Source: 'Struck by Orca,' a book illustrating some of the more bizarre ICD-10 codes