Health care moving to new coding system

Delays in appointments, payments expected after conversion

Local health care organizations want the public to be aware the federal government is requiring the health care industry to transition to an updated medical coding system by Oct. 1, 2014.

The transition will be from the International Classification of Diseases Ninth Revision (ICD-9) to ICD-10.

“Any time a physician diagnoses a disease, an injury or whatever the patient is being seen for that encounter, rather than billing a headache or a cough or bronchitis, it’s billed by code,” said Anne Schutt, a medical chart analyst and auditor at Jefferson City Medical Group (JCMG).

“When he does his assessment and plan, he’ll pull in that diagnosis code for that problem, and that’s what goes to the billing company,” she said.

ICD-9 has been used in the United States since 1979, although other countries have used the updated ICD-10 for some time.

Schutt said the biggest reason for the transition is that ICD-9 couldn’t be expanded any further.

“It’s kind of obsolete at this point,” she said. “With all of the new technology that we have, and further statistical studies for disease control, ICD-9 has met its limits.”

She said ICD-10 will require physicians to be much more specific in their documentation, and the more specific codes will allow the World Health Organization to better research, analyze and monitor health situations of populations and groups.

ICD-10 has 69,000 codes compared with ICD-9’s 14,000 codes.

The ICD-10 go-live date was originally Oct. 1, 2013, but the federal government pushed it back a year.

Area medical entities are in the midst of preparing not only their staff and physicians on how to use the new system, but also are preparing patients for what they can expect.

“Our biggest issue that we can see is slower payments,” Schutt said. “Payments may not come in as promptly as they were and a patient might get information on their explanation much farther out than what they would typically get.”

Schutt said patients should also be prepared for denials from insurance companies.

“Insurance companies may start denying for whatever reason—system issues or doctors not being more specific,” she said. “We want to make sure to give them a heads up prior to going live to expect those delays and issues.”

Deborah Hibdon, chief clinical officer at JCMG, said patients should also expect appointment delays.

“A lot of doctors try to get their documentation done while they’re in their visit,” Hibdon said. “But, it’s going to take more time for these doctors to document.”

She said physicians in other countries that have transitioned to ICD-10 have had a dip in productivity.

“Most are at about 90 percent productivity,” Hibdon said. “It just slows them down. What I would encourage patients to do is if you have your well-visits or annual visit, it might be beneficial to get them done before October.”

St. Mary’s Health Center (SMHC), Capital Region Medical Center (CRMC) and JCMG are training their physicians and staff on ICD-10, gearing up for the Oct. 1 transition.

“We are providing internal education, not only to our coding staff who is going to be assigning the codes, but also our physicians, and our clinical staff as well,” said Teresa Arrowood, director of Health Information Management at SMHC.

She said SSM Health Care, SMHC’s parent company, has a corporate ICD-10 project coordinator.

“From a system perspective, we are training locally, but we have resources available to us systemwide,” Arrowood said.

Rosie Steck, manager of Clinical Information Services at CRMC, said the hospital has a project team with representatives from various departments who are in charge of exploring the impact of the transition of ICD-10 across CRMC’s facilities.

“We have been providing some training for our staff, and after the first of the year, we plan to increase that, ramp that up for very intense training for our staff members,” Steck said. “It will involve instructional training, and interactive instructional training, as well.”

Hibdon said JCMG started training its ICD-10 implementation team in 2010.

“We took a look at the organization and identified everywhere that staff and physicians are currently using ICD-9, so we can have a list of those,” Hibdon said. “Then we have to make sure that we transition all of those processes, forms, everything to ICD-10.”

Schutt said ICD-10’s delay to 2014 put JCMG’s training on hold for a bit, and the organization is just now beginning training.

“We’ve continued planning for it and looking at the implementation process and the budgeting, but you can’t train somebody two years out and expect them to remember the codes,” she said.

She said that after the first of the year, JCMG will begin more intense ICD-10 training and the physicians will begin training in March.

Hibdon said the transition for an organization of JCMG’s size costs nearly $2.7 million.

“That’s when you look at everything — education, staff time out, a decrease in productivity, all those components,” Hibdon said.

She said she hopes everyone, including the public, is aware about the transition by the time ICD-10 goes live in the United States on Oct. 1, 2014.

“I’m just hoping the word gets out,” Hibdon said. “And, it’s not just physicians. Dental offices will have to transition, too.”

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