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Dome - Code huge

February 2011

Code huge

Date: February 7, 2011

The switch to a new coding system for diagnoses and procedures is nearly three years away, but the time to prepare is now.

Head with binary code

Jeff Joy doesn’t shy away from describing the enormous scope of orchestrating the largest computer and billing system overhaul faced by Hopkins Medicine since Y2K 11 years ago.

“This is coming. It’s unavoidable and it will affect every entity throughout the system,” says the chief operating officer for Johns Hopkins HealthCare. “A lot of people look at this just as an IT issue, but it has much deeper roots in our health system.”

What Joy and many others are facing is an October 2013 deadline, by which time health care facilities and providers in the United States must use a new national coding standard for diagnoses and procedures known as ICD-10. After that date, claims submitted using today’s 30-year-old codes (ICD-9) won’t be reimbursed by the Centers for Medicare and Medicaid Services or any other payer. “It has huge implications all over,” notes Joy, one of the co-chairs of a steering committee overseeing Hopkins Medicine’s ICD-10 transition.

More than a slight update from its coding predecessor, ICD-10 vastly increases the number of codes, as well as their level of detail, providing more granular health information that could be mined by clinical researchers, policymakers and others. Rewriting and testing the computer systems that use these codes will alone require a massive effort, but it doesn’t end there.


ICD-10 is “going to take the coordination of an awful lot of people. We have the dedication, but we’ve just got to keep the pressure on.” 

—Paul Allen


Physicians, Joy notes, will need to complete clinical documentation in more detail to help medical coding specialists make the correct selections.

Those coders will need to develop deeper knowledge of anatomy and physiology. Contracts with payers, based on those codes, will have to be revised, as will medical policies.

So while the deadline is yet more than 30 months away, committee leaders say that there’s little time to spare.

ICD-10 is the 10th revision of the International Classification of Diseases, a coding system that was developed by the World Health Organization and has origins in the 1850s. It provides a standard, worldwide language about diagnoses, the causes of death, prevalence of disease, the frequency of certain complications and adverse events, and other health information that is used for epidemiological research, health care management, clinical care and other purposes.

ICD is also used in billing. The diagnosis codes are required in any health care setting, while the procedural codes apply to inpatient facility billing only. (Professional fees and outpatient facility billing will continue to be based on Current Procedural Terminology codes.)

The breadth of change

In October 2013, the number of ICD diagnosis codes will increase from 14,000 to 70,000, while procedure codes will balloon from 4,000 to 72,000. Some of the additional codes are due to new clinical descriptions, as well as codes that wrap up a combination of diagnoses. But the bulk of the increase results from much greater specificity and detail in how these diagnoses and procedures are described.

For instance, when a patient’s artery needs to be sutured, there is now one procedure code regardless of which artery is involved, says Paul Allen, director of Hopkins’ casemix information management. “With ICD-10, there’s a different code for virtually every artery in the body,” he says. The same is true for procedures to nerves and fracture reductions. Physicians will need to write their clinical documentation in sufficient detail so that coders don’t have to contact them for more information.

Allen, also a member of the implementation steering committee, says Hopkins’ medical coding specialists will require additional education, not just in the new coding system, but also in anatomy and physiology, to make the transition.

The more detailed data from ICD-10 could also be used in care management—for instance, to identify groups of patients who could use early interventions. Patient satisfaction results could be richer and more detailed.

Monitoring quality of care could also improve, says nephrologist Paul Scheel, another steering committee co-chair. For instance, it would be far easier than it is today to determine the percentage of patients with bacterial pneumonia who received antibiotics within 24 hours.

The government plans to use the data to measure the quality and efficacy of care.

All of these uses, of course, depend on a smooth transition to the new sets of codes. As Hopkins Medicine prepares for this switch, one of its first steps is cataloging the information systems that use ICD codes, as well as identifying everyone whose work involves those codes, to ascertain what training they may need to get ready for the transition.

“It’s going to take the coordination of an awful lot of people,” says Allen. “We have the dedication, but we’ve just got to keep the pressure on.”

—Jamie Manfuso

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