ICD-10 Is Almost Here – Are You Ready for the Journey?

Pat Stricker, RN, MEd, Senior Vice President, TCS Healthcare Technologies
 
The day we have been waiting for (or dreading) is almost here. Unless there has been some drastic change since the time I wrote this article and the time you are reading it, we will be transitioning to ICD-10 codes in less than two weeks! (If there was another delay announced, just bookmark this for future reference, because the ICD-10 journey will happen someday. If not, buckle up and let’s get ready to go!)

This article is not meant to be a discussion on how to get ready for ICD-10; it’s too late for that. It is also not a tutorial on the format, structure, and use of the codes; I assume you have already been trained on these points (or at least I hope you have). For those of you who want more in-depth information on this type of information, I recommend reviewing the very informative ICD-10 Training Guide developed by the World Health Organization.   

The intent of this article is to share some light-hearted facts and thoughts about ICD-10, provide you with some hints and tips on how to get to the finish line, and make you feel good about where you are in the process. I’d like us to take a few deep breaths and relax before the "big day." If you are all set for the October 1 date, that’s terrific! If you are almost ready, keep going – the finish line is near! If you aren’t ready at all... all I can say is "good luck"!  

Believe it or not, the statistical study of disease began in the 1600s. In 1891, the International Statistical Institute commissioned the development of a classification of causes of death. Over the years, countries began to add data on diseases, morbidity, and injuries. At the 6th International Conference in 1948, this data had evolved into the Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Today, we would describe it as the International Classification of Diseases-6 (ICD-6). The 7th version was released in 1955, the 8th in 1965, and ICD-9 in 1975 (36 years ago). Work on ICD-10 began in 1983 and the diagnosis codes were endorsed for use in 1990, with the full release in 1994. Since that time, 138 countries have implemented ICD-10 for mortality and 99 countries are using it for morbidity. The codes have also been translated into 43 different languages.  

Many of you may not realize what a long process the ICD-10 transition has been for the U.S. Plans for implementation began in 1995, but the HIPAA regulations enacted in 1996 put a regulatory hold on the process. The U.S. did implement ICD-10 for mortality coding only (death certificates) in January 1999, but the decision to standardize the use ICD-10 codes for diagnostic, reimbursement, and resource allocation continued to be delayed by regulatory issues and public comment periods.

In 2003, the Department of Health and Human Services (HHS) was given the responsibility to implement ICD-10. Six years later, in 2009, they announced ICD-10 as the new national coding standard and set an implementation date of October 1, 2013. That decision process and announcement only took 14 years (1995-2009)! Although the implementation process was scheduled for another four years, that was later pushed back to 2014 and then finally to 2015. So, it has taken us 20 years to transition to ICD-10! You can see why people want to see it actually happen. And just in time – ICD-11 is just around the corner! It is scheduled for release in 2018, but let’s not think about that just yet. We need to get ICD-10 up and running first, and then it should be easy to transition to ICD-11, right?

We need to keep in mind why we are moving to ICD-10. It’s not just to keep up with the other countries that transitioned years ago; we need to make this change to improve our health care system. ICD-9 codes are 36 years old and use outdated and obsolete terminology that is inconsistent with current medical practice. The ICD-10 codes use updated terminology and specificity to describe diagnoses and procedures now being used in the 21st century versus those used in the 1970s. Other benefits of using ICD-10 codes include:
To help organizations prepare for the implementation, CMS developed fact sheets to dispel some of the myths and misperceptions surrounding ICD-10. Review the following examples for more detail and a list of even more resources: Five Facts about ICD-10, Five More Facts about ICD-10, and Myths and Facts about ICD-10-CM/PCS.  
                   -Free billing software can be downloaded from Medicare Administrative Contractors.
                   -Part B claims submission functionality is available on about half of the MAC’s provider Internet portals.
                   -Submission of paper claims, if you meet the provisions of a waiver.

OK, we’ve spent enough time on "intellectual" content; let’s take a break and have some fun. Since there are now 68,000 codes instead of a mere 14,000 codes, and we have seven digits to use to give us much more specific descriptions of diagnoses, that has resulted in some rather weird and silly diagnoses:   
NOTE:   "Subsequent encounter" means this is the second encounter with a health care provider as a result of the original event, not that it happened the second time.

Yes, these are legitimate ICD-10 codes. Even though our chances of being struck by a turtle or a macaw in a metropolitan city in the U.S. are slim, we have to remember that it might be more common in other parts of the world. Even though they sound weird, can you see how this type of specific information will allow us to categorize and analyze injuries in a more meaningful way? Based on specific diagnoses, we will also be able to better analyze the types of interventions and treatments that provide the best outcomes. And if we can do that with these types of "silly" diagnoses, imagine the kind of data we will be able to analyze using realistic clinical diagnoses. If you want to have fun practicing the use of the new ICD-10 codes, check out this interesting training tool that uses humorous case studies. And, just for fun, here are some videos of The Top 5 Zaniest ICD-10 Codes. While these are fun and light-hearted, it is now time to get serious again and focus on what needs to be done in the last few weeks leading up to October 1.  

In the time left, you need to focus carefully on making sure you are as prepared as you can possibly be. There are a myriad of tips and tools out there to help those who still aren’t quite ready, but the following two resources are "must reads."  The ICD-10 RoadMap Tool Kit and the ICD-10 Checklist for Implementation Readiness provide ideas and suggestions for the last few weeks of implementation and for the actual "go-live" period. Other helpful websites include:
There are basic processes that need to be focused on to prepare for a smooth transition.  Review the following list and make sure that you focus on those items related to your role in the organization.  
These are suggestions for "go-live" and the first two weeks after transition:
The impending transition to ICD-10 has caused an unusual amount of angst for the health care industry. Given the overall changes and highly sophisticated health care procedures available today, should implementing a new set of diagnostic codes generate this kind of turmoil? Sure, they have caused an enormous amount of extra work to prepare for the change; they will cause a slowdown in productivity; and they will cause financial issues with payments, revenue, and cash flow.

But it’s not all "doom and gloom"! Aren’t we always in the middle of some type of major change in health care? We’ve made it through other major changes in the past, such as Medicare, Medicaid, ICD-9, managed care, DRGs, and the Affordable Care Act. And other countries have implemented ICD-10 codes years ago without a major catastrophe. So why can’t we? We have spent 20 years thinking and planning for it, so I’m sure we can do it. Sure, there will be issues and some may be major, but once the transition is made, we will probably look back and say "that wasn’t so bad." 

Remember how difficult it was when computers, and then cell phones, started to invade our quiet, organized lives? Most of us resisted and vowed we would not be tied to our phones, texts, email, and the Internet.  Now, can you even imagine not having them? They run our lives. Change is inevitable, and we will get through this transition.

If you have prepared well, it’s time to take a deep breath, relax, and get ready for "smooth sailing." If you haven’t prepared as much as you should have, hold on and get ready for a bumpy ride. We will all eventually get to the same place, but our ride and experience may be different. Bon voyage!      

Pat Stricker, RN, MEd, is senior vice president of Clinical Services at TCS Healthcare Technologies. She can be reached at pstricker@tcshealthcare.com.