In just a few short months, the codes that health care organizations use to describe patient care will become standard across the globe. It’s the first time in more than 30 years that all health care organizations will use the same system for reporting patients’ diagnoses and procedures. The change that will make this sweeping impact is the mandated transition to the ICD-10 coding system on October 1.
Last year, Texas Children’s launched its efforts to be ready for the mandatory implementation of ICD-10. On October 1, the current ICD-9 code sets that have been used to report medical diagnoses for the last 30 years, as well as inpatient procedures, will be replaced by ICD-10 code sets.
“We believe that communicating this change clearly and consistently will help all of us make the transition,” said Texas Children’s Chief Safety Officer Dr. Joan Shook. “Some of the tools we’ve developed – like a fact sheet that answers frequently asked questions – are specific to this change, while other times we use existing hospital and provider publications to keep everyone informed.”
The transition to ICD-10 is required for organizations covered by the Health Insurance Portability Accountability Act (HIPAA). This includes hospitals, clinics, laboratories and other providers of ancillary services (i.e., radiology, rehabilitation, psychiatry, home health, etc.).
What is ICD-10?
ICD-10 is the abbreviated term for the 10th revision of the International Classification of Diseases. It’s a coding system used to report and code diagnoses, injuries, impairments and other health problems and their manifestations. ICD-10 was implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, the current coding system used at Texas Children’s. ICD-10 is the standard coding system used in almost every country in the world, except the United States.
So why the change to a system that seemingly worked in the U.S. for 30 years? The current ICD-9 system has simply run out of space to accommodate new diseases and procedures. The data fields are limited, are not sufficient for accurate medical research, and the system doesn’t support the exchange of health data with other countries. Because the system is 30 years old, it has many outdated or even obsolete terms and is not consistent with current medical practices.
Finally, it lacks sufficient detail to be able to understand exactly what care was given. Many discoveries have been made in the past few decades, and the structure of the current coding system is not designed to expand for the inclusion of specific details and new advances in medicine.
Why it matters
The specificity that the ICD-10 codes will allow is perhaps the most important change that will be realized with the conversion. The ICD-10 codes allow greater specificity and exactness in describing a patient’s diagnosis and in classifying inpatient procedures. For example, after the conversion to ICD-10, an accidental fall can be classified as a fall from a specific type of playground equipment (i.e., fall from playground slide), or asthma can be coded by degree of severity.
“This information will provide a better record for everyone, from providers to billing staff, on what care a patient receives,” said Texas Children’s Chief Nursing Officer Lori Armstrong. “And we all know that the more specific and comprehensive that data is, the more useful it becomes.”
The increased level of detail within ICD-10 more accurately reflects the care provided. Better quality data can reveal patterns of care and other insights that help caregivers make better decisions and achieve better outcomes.
From a financial perspective, conversion to ICD-10 allows performance-based payment systems, more accurate data and more accurate billing. The billing process is more streamlined, efficient and more robust, which helps prevent fraud and abuse.
“ICD-10 provides an opportunity for Texas Children’s to elevate the specificity and scope of our collective clinical documentation efforts,” said Robert Mattix, vice president of Revenue Cycle Administration. “Our organization-wide ICD-10 preparedness is critical to capturing information for quality measurements, such as AHRQ Pediatric Quality Indicators, CHCA complications and mortality, and appropriate third-party reimbursements.“
Getting ICD-10 ready
Texas Children’s ICD-10 preparedness teams already have been working diligently for months to ensure we are ready for the mandatory October 1 conversion. The most important action everyone else can take is to get educated and be ready for the transition, as it will impact physicians, coders, billing staff, nurses, lab, front desk and many other areas.
The two roles most affected by the ICD-10 conversion are physicians and coders. For the medical staff, Texas Children’s is partnering with Baylor College of Medicine (BCM) to provide e-learning videos. Physicians’ education will be specific to their respective specialties and will fulfill the education requirements for both Texas Children’s and BCM. The coder staff will attend an on-site ICD-10 coding boot-camp for training and education.
For the other impacted roles, the ICD-10 education team has prepared a role-specific curriculum offered online.
“If we all focus on educating ourselves over the coming months, the result will be a smooth transition come October 1,” said Myra Davis, senior vice president of Information Services. “In the end, the goal is worth it: to improve the quality of our operations and ensure even better outcomes for our patients.”
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