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ICD-10 to Launch Oct. 1

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ICD-10 to Launch Oct. 1

ICD-10 to Launch Oct. 1

Date: 05/01/2015

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 have already begun 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,” he says.

“There is growing anxiety about ICD-10 and what it means,” says Stephen Sisson, executive director of ambulatory service at The Johns Hopkins Hospital and physician co-director of education outreach for the ICD-10 launch. “Epic really does walk you through that coding. 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.”

Comprehensiveness and Precision

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, 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 different code for every imaginable injury, inspiring journalists to note that there are codes for such unlikely scenarios as being injured in a spacecraft or deep freezer.

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.

Impact on Research and Clinical Practice

“That level of specificity is going to make it easier for us to do public health, research and financial analysis,” says Jennifer Parks, director of clinical integration in the Office of Johns Hopkins Physicians.

For a recent project, she and a colleague analyzed the reasons that patients in community hospitals were transferred to The Johns Hopkins Hospital. “We were looking through all our coding data to determine why patients were transferred and what happened to them after they got to East Baltimore, the objective being to determine who could have stayed in place. The codes from ICD-9 weren’t specific enough.”

Parks cautions that clinicians might see an initial slowdown in their cash flow, because denials may be more common in the early days of use, as physicians and coders adjust to the new system.

Epic’s Role

Fortunately, Epic is smoothing the path. Whitted notes that Epic already prompts 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. For entities that do not yet use Epic, including inpatient departments at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, ICD-10 mitigation planning is currently underway and is on target to meet the Oct. 1 implementation date.

Whitted believes the migration to ICD-10 will be so intuitive, it will require little or no physician training beyond information in Epic newsletters, the online ICD-10 training modules and 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.

That will improve patient care, says Parks. “ICD-10 allows a better description of patients, their conditions and their treatment. When those patients go from doctor to doctor, place to place, that specificity should improve continuity of care and communication. That’s the best part of it.”