Industry Insight

Navigator talks with 3M experts Rich Averill, senior vice president of Clinical and Economic Research, and Rhonda Butler, ICD-10 expert from the Clinical Research team, for their insight on the benefits of ICD-10 and what you can do to prepare for success.

Rich Averill
Senior vice president of
Clinical and Economic Research

Rhonda Butler
CCS, CCS-P
ICD-10 expert from the
Clinical Research team

Navigator: We’ve been hearing about ICD-10 for years. What has really changed with the Aug. 15 announcement from the Department of Health and Human Services (HHS)?

Averill: ICD-10 is the coding standard used in most countries around the world to classify diseases. Developed by the World Health Organization (WHO), ICD-10 has been published in 42 different languages, and most countries use it for both mortality and morbidity reporting. Although ICD-10 has been used in the United States since 1999 for mortality reporting, ICD-9-CM continues to be the coding standard used to classify healthcare diagnoses and procedures for reimbursement and other administrative and quality reporting purposes. The National Center for Health Statistics (NCHS) has refined the WHO ICD-10 diagnosis coding system for use in the U.S. by developing the ICD-10 Clinical Modification (ICD-10-CM). Since ICD-10-CM is exclusively a diagnosis coding system, the Centers for Medicare and Medicaid Services (CMS), developed the ICD-10 Procedure Coding System (ICD-10-PCS). In the U.S., the term ICD-10 refers collectively to ICD-10-CM and ICD-10-PCS.

The Aug. 15 announcement is a very important step in the adoption of ICD-10 as the new national coding standard in the U.S. HHS is formally calling for the ICD-9-CM code sets to be replaced with ICD-10 code sets, effective Oct. 1, 2011. This is a proposed rule and an approval process is still ongoing, but most agree that the adoption of ICD-10 is long overdue, and even organizations that object to the proposed timetable support the transition. ICD-10 will enable the industry to more fully support quality reporting, pay-for-performance, bio-surveillance and other critical activities. It’s an essential move for the industry as the delivery of health care becomes increasingly complex. We can no longer postpone the financial and clinical benefits of a comprehensive and modern ICD-10 coding system.

Navigator: On a high level, what is the principal difference between ICD-9 and ICD-10?

Butler: While ICD-9 contains 17,000 codes and cannot keep pace with advancing medical knowledge and technology, the ICD-10 code sets contain more than 155,000 codes designed to better capture current understanding of disease and more clearly and completely specify the procedures performed. The ICD-10 code set allows for more complete capture of clinical information. Coders will have the opportunity to use more specific information in the medical record that may have previously gone uncollected for coding purposes. It offers greater coding accuracy; supported by clear, complete documentation, it will provide better data to support fair payment and more accurate quality measurement. The precision of ICD-10 is an important step in the transition to electronic health records.

Navigator: Why are some organizations concerned with the implementation schedule?

Averill: It comes down to system changes and education and training. The shift to coding under ICD-10 will require more precise clinical documentation, so physicians will need to be educated in capturing all of the necessary information needed for coding. The accuracy of documentation and efficiency of managing it will be more crucial than ever. Coders too will need training in how to code under ICD-10. Also, ICD-10 will require updates to systems that contain or use diagnosis and procedure codes across the continuum of patient care—including health information management (HIM), patient financial services (PFS), information systems and clinical systems. With careful planning and the right information and support—including mapping, trending, access to nosology expertise and staff education—healthcare organizations can prepare, efficiently transition and then thrive with the new system.

Navigator: What are the first steps an organization should take to prepare for ICD-10?

Butler: For HIM professionals, the first step is to determine the educational needs of the coding staff, including proficiency in medical terminology, detailed knowledge of anatomy and comprehension of operative reports. Professional organizations such as AHIMA, colleges and universities with health information programs and vendors will provide educational support for the transition.

Averill: ICD-10 will require increased collaboration with the medical staff. HIM professionals should begin the education process well in advance of ICD-10 implementation to ensure physicians understand the link between documentation and accurate coding under ICD-10. For hospital leadership, preparation should include creating ICD-10 awareness throughout the organization, determining educational and project management needs for each department involved and plan for the necessary resources during the transition period.

Butler: IT departments should focus on assessing systems that currently contain ICD-9-CM codes (including inventory databases and decision support systems) and evaluating interfaces between HIM code entry and UB-04 billing. Take a close look at your vendors to ensure each one will update their systems to accommodate the new code sets. It’s important that IT departments determine how to compare data based on ICD-9 with ICD-10 codes. Most hospitals will find it necessary to conduct studies and produce reports that span a period before and after ICD-10 implementation, so they will need to create applied mappings across data sets that are appropriate to their purpose. Since all payers may not implement ICD-10 at the same time, dual systems may be needed during the transition period.

Navigator: What else can organizations do now to convert their systems and applications to accurately and efficiently handle ICD-10 codes?

Butler: There are public domain General Equivalence Mappings (GEMs) between ICD-10 and ICD-9-CM—both diagnosis and procedure mappings—supplied by the NCHS and CMS, respectively. GEMs are best understood as an unabridged translation dictionary that presents useful translation options between the two code sets. A single map cannot serve all purposes. However, healthcare organizations can use the GEMs to create applied mappings to meet their specific needs. 3M Health Information Systems is using the GEMs to convert the current CMS MS-DRGs to a version that uses ICD-10 codes, the first ICD-10 grouper conversion project of its kind in the United States.

Navigator: How long has 3M Health Information Systems been involved with ICD-10?

Averill: We’ve been directly involved with ICD-10 since 1995, when CMS awarded 3M Health Information Systems a three-year contract to develop the ICD-10 Procedure Coding System. Currently, CMS contracts with 3M for the annual update and maintenance of ICD-10-PCS. We’ve also developed the official mappings between ICD-9-CM and ICD-10-CM and ICD-10-PCS under contract to CMS. On the international front, we are leveraging more than a decade of experience in developing and implementing ICD-10-based coding and grouping products.

Four sessions at AHIMA 2008 offer timely information about ICD-10:

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