Ready for ICD-10

The switch to ICD-10 is expected to be smooth for Johns Hopkins Medicine.

Published in Dome - June 2015

On Oct. 1, health care organizations nationwide will switch from the ICD-9 billing code system to the more detailed ICD-10. Johns Hopkins Medicine will be ready, says M. Tyrone Whitted, interim senior director of compliance and training in the Office of Billing Quality Assurance. In fact, most doctors may barely notice the change, because they are already providing more detailed documentation within the Epic electronic medical record system.

“If they document and bill through Epic, by the time Oct. 1 comes around, it will be just another day,” Whitted says.

More than 100 countries facilitate record-keeping and research around the world through use of the International Classification of Diseases, or ICD. In the U.S., the change from ICD-9 to ICD-10, first announced in 2008, was delayed three times by the Centers for Medicare and Medicaid Services amid concerns about transitioning from a template with 14,000 codes to one with nearly 70,000.

One goal of ICD-10 is to provide a unique code for every imaginable injury, inspiring observers to note that there are codes for such unlikely scenarios as being injured in a spacecraft or deep freezer.

More usefully, the ICD-10 codes add such details as whether the diagnosed injury or ailment is on the patient’s right or left side and how it is progressing over time, explains Ruth Spangler, interim director of the Office of Billing Quality Assurance’s operations. For example, all broken ankles are assigned the same ICD-9 code. But under ICD-10, the code also reflects the type of fracture, whether it is the right or left ankle, how long ago the injury took place and whether it is healing.

Whitted says Epic is already prompting clinicians to enter such details through a diagnosis calculator that is being updated several times to reach the level of specificity required by ICD-10. In entities that do not yet use Epic, including inpatient departments at Johns Hopkins Bayview Medical Center and The Johns Hopkins Hospital, the existing medical record systems are being updated the same way, Whitted notes.

“I know there’s always been some concern because it will be 70,000 new codes,” says Whitted. “But with the Epic system’s diagnosis calculators, clinicians don’t need to necessarily know the code. Epic will get them to the code.”

“Epic really does walk you through that coding,” agrees Stephen Sisson, executive director of ambulatory service at The Johns Hopkins Hospital and physician co-director of education outreach for the ICD-10 launch. “Clinicians don’t need to memorize a ton of codes. What’s important is that they continue to appropriately document the level of detail that supports the billing code they submit.”

Whitted believes the migration to ICD-10 will be so intuitive, it will require little or no physician training beyond information in Epic newsletters and in other institutional communications. Moreover, Sisson says, the time doctors spend providing additional information yields benefits beyond ICD-10. “Good documentation really is the key to communicating with other clinicians,” he says.