2013 implementation looms

One organization called it “the greatest change since the advent of computers" in health care. Full implementation of the ICD-10 coding system for health care is still nearly four years off. But the complexity will make every bit of that time necessary for ICD-10’s adoption.

The International Classification of Diseases system is so ingrained, most people in health care aren’t even aware they are using it just about every day.

“A few weeks ago I was in the doctor’s office and I asked a nurse about the upcoming change,” says Rebecca Fortuine, training & quality specialist for CareOregon. “The nurse answered that she didn’t do anything with codes. Then she wrote me a referral with the diagnosis code.”

Rebecca, working closely with Cristie Lende, is the project manager for the ICD-10 change process for CareOregon. They will be spending the next few years making sure that CareOregon’s staff, computer systems and providers can make the change smoothly.

It’s been a long time coming, Rebecca says. In 1979, delegates to the World Health Organization authorized development of ICD-9, the current system.

But while other nations have made the change from the old system, the U.S. remains the last industrialized nation to make the switch.

And it’s needed, Rebecca says.

The U.S. health care system currently uses the old ICD-9 system, which uses mostly numerals in the coding, and a maximum of five characters. That means the number of unique codes in ICD-9 is limited.

“There have been huge developments in the medical world since 1979,” Rebecca says.

This year 2009 Influenza A (H1N1) virus was a new diagnosis with its own code. That's one example of the number of new codes needed every year, and ICD-9 is running out of room for new combinations.

ICD-10 uses seven characters, and both numerical and alphabetical characters are used. That makes possible many times as many codes .

ICD-10 can be much more specific and detailed, making it a real boon to researchers. “We can compare things down to the nitty gritty,” Rebecca says.

The U.S. health care system is mandated under a provision of the 1996 Health Insurance Portability and Accountability Act (HIPAA) to make the change in 2013.

The change will be laborious. Every health plan, provider clinic and hospital will have to evaluate their computer systems to determine what they will have to change. Making sure that computers can communicate with each other using the longer alphanumeric codes is one of the important steps to full implementation.

CareOregon will collaborate with its provider network, Rebecca says.

“We will be looking into ways we as a community can help each other through the process,” she says. One of the first steps has been to share information with the network.

“We have already taken steps to advise our network of providers, clinics and hospitals,” Rebecca says. “We’re advising people about the web site the Centers for Medicare and Medicaid Services (CMS) has established.”

That site is www.cms.hhs.gov/ICD10.

Over the next couple of years, CareOregon will be changing over its computer system, as will most other health care organizations.

For those who will need to use the codes in the delivery of care, the transition may be a few years off. At least one medical professional organization has told its members to not try to learn the coding any earlier than 2012 out of fear that learning it too early might make a refresher course necessary.

For more information, see http://www.ahima.org/icd10/understanding-icd-10.html.

Providers with questions about CareOregon’s implementation of ICD-10 should review the “What’s New for Providers” page of the CareOregon web site or contact your Network Relations Associate.