Oct. 04--WATERTOWN -- A recent revision of the nation's uniform health care coding system will provide the medical industry with a more detailed set of diagnostic information, but the learning curve for providers is steep.
Thursday marked the deadline for implementation of the International Classification of Diseases 10th Revision, more commonly known as ICD-10.
The coding system replaces the outdated ICD-9, which was finalized in 1979. It is what hospitals, clinics, private practices, emergency medical staff and all other health service providers use to code every diagnosis, symptom and procedure experienced while on the job.
Corey M. Zeigler, regional chief information officer for the Fort Drum Regional Health Planning Organization, said this revision is a big undertaking, but it is worth it.
"The current code set is really quite old," he said. "Obviously, the medical services, the technology and the things that we do have changed considerably."
Under ICD-9, about 13,000 codes existed. Now, with ICD-10, more than 68,000 are in place and some are incredibly specific.
For instance, code V97.33XD is used when a person has been sucked into a jet engine and is visiting a physician for a subsequent encounter.
Or, if a doctor should happen to use code Y93.D, that means the patient was injured while doing arts and crafts.
And if by chance one has been burned because his or her water skis were on fire, there is code Y93.D:V91.07XD.
While some of these codes may seem unnecessary, Mr. Zeigler said, it is better to have them than not.
"Maybe we will get some trends of data that we didn't have before," he said. "The data set that we get out of this is the big advantage; it will be much, much deeper and much more specific and valuable to the users."
Once a doctor has completed a narrative for a patient, containing background information, symptoms, a diagnosis and other pertinent information, Mr. Zeigler said, that narrative is sent to a coder.
In the past, he said, categories were too broad and coders were forced to make decisions about the patient to choose the appropriate code.
Now, the coders can move through a classification system, which helps them arrive at the correct code after working through a series of questions.
"With the new system, it's a branching logic," he said. "You proceed through a group of categories, going down a lateral chain. It has to be much more specific than it was in the past."
Specificity is also important because codes are used for billing, he said.
"We risk-adjust patients, meaning that when we provide care, the cost is compared to the condition that the patient has," he said.
Mr. Zeigler said the United States is one of the only countries that use the coding system for billing services, which is why many other industrial countries already have implemented ICD-10.
For some insurance companies and providers, getting used to the new system will take time. Training employees will cost money.
Industry recommendations call for all practices to have about 60 to 90 days' worth of cash on hand to help during the transition period, which poses a problem for some smaller private practices.
"It's a complete different way of coding and billing," Dr. John S. Burnett said. "For somebody in private practice, it's an owner's burden for cost and training and implementation."
Dr. Burnett owns the Massena Family Practice at 173 E. Orvis St. He said having the recommended amount of cash on hand is not feasible.
He said he also is worried about insurance companies getting lost in the learning curve.
"The patients should know that this is a big deal," he said. "It will be interesting to see in the coming months if patients are having billing problems."
Fortunately, Mr. Zeigler said, Medicare is prepared for a period of transition.
"The good news is that Medicare in particular has given a bit of a leniency time frame where they will pay the bill no matter what it is coded," he said. "If there's an error or something like that, it will still get paid."
And it is likely that errors will occur, he said.
At River Hospital, Alexandria Bay, CEO Ben Moore III said there were a few technical difficulties using the system on implementation day.
"We found some of the software was not synchronized with other software," he said. "We took part of our system back to manual until we had things figured out."
Mr. Moore said all of his staff members seem to be understanding the codes and the issue was just a technological glitch.
He said the hospital has been preparing for the implementation for a while and he expects that things will run smoothly after all technical details are ironed out.
"I understand that the fixes have all been identified," he said. "As far as long-term usage, I understand the benefit of this new coding system is that people will be far more able to track what is going on with various conditions and be able to make better judgments."
Mr. Zeigler reinforced this point.
"I think that the key is that we can't let our guard down and we have to continue focusing on improving the quality of clinical documentation," he said.
He said FDRHPO staff will be available to help all local providers make the transition into ICD-10.
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