NEHIMSS Monthly Event and Social: “ICD-10”


The New England Chapter of HIMSS had their Monthly Event and Social last week at Papa Razzi in Wellesley, MA.  There was a great turn out, including many first time attendees.  The topic of this month’s meeting was ICD-10.  The presenters provided a great overview of ICD-10, how it compares to ICD-9, as well as identified some of the most common and significant concerns about the historic change.

  • Currently, there is a CMS mandate to be compliant with ICD-10 by 10/01/2013.
  • The United States is the last industrialized nation to adopt ICD-10.  Some countries have been utilizing ICD-10 for years and are now looking down the road at ICD-11.

ICD-9 is approximately 30 years old and is running out of codes. With age, the standard has lost some of its effectiveness.  For example, ICD-9 has no code to describe H1N1 (Swine Flu), an outbreak that effected tens of millions of Americans over the past few years.

One of the perceived benefits of adopting ICD-10 is the level of specificity with which diagnoses and treatments can be described.  There are 14,000 ICD-9 codes, which are composed of 3-5 digit numbers. By comparison, ICD-10 has more than 68,000 codes, which are made up of 7 character alpha-numeric sequences. Transitioning to ICD-10 will mean a five-fold increase in the number of available diagnosis codes. 

 An example referenced during the presentation concerned an ‘open wound on finger’. Using ICD-9 there are three codes available to describe that diagnosis.  Under ICD-10 there are about 400 codes that could apply.  Again, that is directly related to the level of specificity used to describe the wound, combined with putting it into an historical context.  For example, ICD-10 can be used to specify the finger (ie ‘left ring finger’), whether or not the nail was damaged, and whether the diagnosis is being made as part of an initial or subsequent encounter. Below is a diagram from the General Equivalence Mapping (GEM) user guide, published by CMS. 

Note that the same ICD-9 code is used for all four scenarios.

The participants in the event’s panel discussion provided some interesting insight regarding how their respective organizations are working to prepare, train, and ultimately implement ICD-10.  Two common themes discussed by several presenters were that importance of both senior management and physician ‘buy-in’, as well working with the Massachusetts Health Data Consortium to help ease into the transition with providers.  In one example, provided by Lahey Clinic, coders provide feedback to doctors after audits of their computer assisted coding have been reviewed.

Ultimately, physician acceptance and adoption will mostly likely be correlated to policy of CMS to withhold Medicare and Medicaid payments from doctors that are not using ICD-10.

 In the days following the November NEHIMSS event, the American Medical Association (AMA) announced its intentions to stop the implementation of ICD-10:

“RESOLVED, That our American Medical Association vigorously work to stop the implementation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine (Directive to Take Action); and be it further”

“RESOLVED, That our AMA do everything possible to let the physicians of America know that our AMA is fighting to repeal the onerous ICD-10 requirements on their behalf. (Directive to Take Action); and be it further”

“RESOLVED, That our American Medical Association work with other national and state medical and informatics associations to assess an appropriate replacement for ICD-9. (Directive to Take Action)”

 Galen Healthcare Solutions offers project management, implementation, and training solutions. Contact us to find out how Galen might assist your ICD-10 transition.

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