Sea Changes Can’t Be Overnight Occurrences

October 12, 2010 at 10:44 am Leave a comment

September 30, 2013

Patients receiving treatment at a health facility in the US will be assigned ICD-9 codes for their diagnoses.

October 1, 2013

Patients receiving treatment at a health facility in the US will be assigned ICD-10 codes for their diagnoses.

…What a difference a day makes.

As mentioned previously on this site, ICD coding system is an excellent, standardized way of tracking important diagnostic information. The current system in place is ICD-9, which has about 17,000 codes, and is used for symptoms, diagnoses, injuries, diseases and all other disorders facing patients. The new system is ICD-10, and it will have 155,000 codes – covering the same grouping of symptoms, diagnoses and the rest as ICD-9 – but with a lot more specificity.

I’ve been of the opinion that this transition wouldn’t be too painful. In fact, with the intelligent structure of the ICD-10 codes, where each character represents a specific quality of that code (such as location in the body, severity, etiology, etc.), I thought it could be a real boon to medical professionals. Sure, it would be a hard adjustment, but it’s one that’s about 15 years overdue. As I continue to read about ICD-10 and its impending implementation, I was curious about the plan for phasing it in to the current workflow. Based on everything I’ve read so far – I have a confession to make:

I was wrong – this is going to be a disaster.



Okay, perhaps I am being a bit dramatic. But there is legitimate cause for concern.

According to the AMA, AHIMA, CMS and other organizations in the know – ICD-10 codes will not be accepted until October 1, 2013. That means that while you can test the codes and your system for publishing or selecting your codes – you cannot use ICD-10-CM in a live environment until October 1, 2013.

Why is this a cause for concern?

Imagine if everyone’s area codes, nationwide, changed overnight with every zone having a new area code the next day. How would that work out? There would be some information printed up and resources online in a campaign to ensure that people will use the right numbers. But those numbers won’t be available until that initial, national day. And on that day of implementation? There’d be a lot of confusion, mistakes, calls not getting through and additional time spent having to re-check and learn which codes go for which location. Make no mistake – the new area codes could make a lot more sense geographically and be easy to figure out the logical succession of numbers; but assuming that an entire nation of users will be able to transfer over to this new way without any large mishaps is a recipe for an overnight success.

In other words, the exact opposite of this album cover...

I understand the theory of having a 1 day deadline – it ensures adherence to standards and protocols. I rail on about structured data because I think that when it comes to documentation and reporting, it’s important to have these standards in place. And no matter how ICD-10 is rolled out, there has to be one day when it is the only form of diagnostic coding accepted. It’s the timeline and schedule leading up to that crucial first day that is in question in this post.

The AMA has published its 3 year timeline for facilities to follow when transitioning to ICD-10. It includes interacting with vendors, training the pertinent personnel and testing the internal system. It makes sense and is a good, albeit vague, road map for health facilities to follow as they prepare their workflow for this change. The only problem is that it needs the facilities to already be working on implementing ICD-10: they already need to be aware of the changes, in conversations with vendors and getting pricing on the programs needed to make the change. As a vendor who deals in medical codes, I can tell you: those codes aren’t even ready yet. There is a rough draft of the unfinished codes available at Centers for Medicare & Medicaid Services (CMS) – but there will continue to be additions and alterations even after ICD-10-CM is officially adopted and in use. But it’s very hard to find it in any form that can be used by software developers (or else it’s being sparingly doled out and controlled by a small number of coding companies).

Right now, we (the health IT community) do not have as much access to this information as we need in order to help you (the health professional community) make informed decisions on what programs or what costs will be associated with any of these changes.

I really like ICD-10-CM. I think its layout makes a lot of sense. I think its precision and logical internal structure will end up being a huge help for researchers and to make certain that health professionals are paid correctly. I don’t think adapting to ICD-10 from ICD-9 will be that big of a hassle – but that doesn’t mean it should happen on a national scale at the stroke of midnight. This is coding that affects billing, health treatment and, eventually, people’s lives – not some dubious mystical deadline from Cinderella.

What I am proposing is a more phased implementation. I don’t pretend to know how it would be organized – by location, by types of diagnoses, specialty, or whatever. But I do know that people are used to hybrid solutions. Take, for example, the move from paper, analog medical records and electronic health records – that is not going to be a flip of a switch to change it. It is a process of phasing out certain techniques and processes while converting them into a new format. It requires hiring new personnel, training current personnel and a revision of workflows and information infrastructures. Hospitals are making the transition from paper to electronic in waves – a careful and methodical approach that reveals any problems that might arise from a new way of doing things. If the change to electronic records was handled the same way, there would be a computer crash and absolute halt of medical services across the nation.

ICD-10-CM won’t be that big of a change – if handled properly. If coders are allowed to submit the codes earlier and become more familiar with them over a period of years. If vendors are able to get better access to the data to use in their development sooner rather than later. If everything is approached in a calm and intelligent manner, the transition will still require adjustments and cause some stressing. But if it’s done in a phased implementation, then the differences won’t be night and day.

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