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Update of diagnostic coding system rolls on

May. 30, 2013, 10:56 AM

In health care, narrative descriptions of symptoms, diseases, injuries, complaints, disabilities and procedures are routinely transformed into numeric or alphanumeric codes, facilitating billing, clinical research and the analysis of health care cost and quality.

For example, 780.52 is insomnia, 571.4 is chronic hepatitis and 380.12 is acute swimmer’s ear.

By Oct. 1, 2014, U.S. health care payers and providers will adopt a modified and greatly expanded version of the code set used for diagnoses and inpatient procedures. The ICD-10 code set — International Classification of Disease and Related Health Problems, Tenth Revision — will replace ICD-9, which has been in use in the United States since 1979.

The switch was originally planned for October 2013 but the Department of Health and Human Services pushed the deadline back a year to give health care providers additional time to prepare.

Vanderbilt University Medical Center will aim for full adoption by July 2014, according to Jennifer Causey, administrative director for Vanderbilt’s ICD-10 transition. The remaining steps for a smooth VUMC transition to ICD-10 include training clinicians, coders and staff, and updating applications and databases that use ICD codes.

Training will be piloted in July in Rehabilitation Services and will spread to the rest of the Medical Center over the remainder of the year.

The level of specialization in health care is such that no one works with more than a sliver of the ICD code set. According to Causey, some 7,000 faculty and staff will need some level of training to use ICD-10, but a brief online tutorial will suffice for a great majority of these people.

Clinicians will need more in the way of instruction, but Causey expects that no one other than medical coders will require more than an hour or so of training. She will work with individual department heads to assess training needs for each area.

More than 70 system applications in use at VUMC will require modification for ICD-10. Inpatient medical coders will be introduced to new software that assists ICD-10 coding, and by this December ICD-10 will begin to be integrated into VUMC clinical documentation systems.

As medical knowledge has advanced, ICD-9 has become outmoded, lacking space for new codes and thus sacrificing physiologic and anatomic specificity. ICD-10 codes have a limit of seven characters, compared to ICD-9’s five-character limit.

Mike Leavitt was secretary of HHS when the switch was originally proposed in 2008.

“The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay-for-performance, bio-surveillance and other critical activities,” Leavitt said in a press release issued at the time.

Most of the world’s developed countries made the switch in the 1990s, leaving the U.S. as the last holdout among industrialized countries.

At VUMC, besides Causey, other leaders for the transition include Nancy Evans, Gary Perrizo, Danny Bonn and Theresa Zuckowsky. The physician champion for the transition is VMG Chief Medical Officer Paul Sternberg Jr., M.D.

For more information visit VUMC’s ICD-10 transition website  (Vanderbilt login required).

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