January 27, 2011

Providers bracing for big changes to clinical diagnoses

Providers bracing for big changes to clinical diagnoses

All across the health care system, narrative descriptions of symptoms, diseases, injuries, disabilities and procedures are routinely transformed into numeric or alphanumeric designations, facilitating not only billing and payment but also 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 swimmers' ear.

By Oct. 1, 2013, 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, that is, 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.

Like other providers, Vanderbilt University Medical Center will need to: train clinicians and coders; figure out how the switch may affect fee schedules and revenue; modify all databases and applications that use ICD codes; and coordinate the switch with payers, vendors and clinical benchmarking partners.

The U.S. Department of Health and Human Services proposed the switch 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,” said Mike Leavitt, who was secretary of HHS at that time.

The HHS proposal later became a mandate extending to all organizations that handle electronic patient information.

The switch to ICD-10 began internationally in the mid-1990s (the World Health Organization governs revision of ICD code sets).

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.

“For providers, the transition to ICD-10 involves a host of operational, technical and financial issues,” said C. Wright Pinson, MBA, M.D., deputy vice chancellor for Health Affairs and senior associate dean for Clinical Affairs at VUMC.

“To make this transition as smooth as possible, besides careful planning, we'll also need the cooperation of many, many staff and clinicians,” he said.

The ICD-10 project team is headed by Wendy Leutgens of Vanderbilt University Hospital Administration, Nancy Proctor of the Informatics Center and Gary Perrizo of Finance.

A team of consultants has been conducting a 12-week assessment, meeting with staff and faculty across VUMC.

The switch to ICD-10 does not affect the American Medical Association's CPT (Current Procedural Terminology) code set, which clinicians use to document procedures and services.