The U.S. Department of Health and Human Services (HHS) has determined that all hospitals and providers will begin submitting bills to the government and third parties with the ICD- 10 (International Classification of Diseases, 10th edition) diagnostic and inpatient procedural coding terminology effective Oct. 1, 2014. The rest of the world has been on ICD-10 for the last 20 years and getting ready to move to ICD-11, so don’t expect another delay like last year’s reprieve. So what’s the big deal? It’s only billing codes.
Our current information technology systems are designed around the ICD-9 CM code set. To get ready for ICD- 10, all of these systems must be remediated. This includes Cerner, SoftMed, NeoData and every other application at CHOC that codes a diagnosis or procedure, or supports sending out a bill (and any other report or process utilizing diagnostic codes). It’s not just a hospital problem. This change also impacts any applications currently running in community physicians’ private offices.
The good news is that CHOC is nearly complete with its remediation efforts. We hope those in private practice are, as well. The bad news is that it is absorbing millions of our capital dollars. It’s also a burdensome expense to practices. We are installing our second new version of Cerner code in May that is fully ICD-10 compliant and allows us to do coding in both coding formats for some period of time prior to the go live date in October. It’s our second code upgrade within one year, versus the usual pace of one upgrade every one or two years. That creates more change than we usually like to absorb. But that’s the world of IT these days.
In addition to remediation, we will be installing new software systems to meet the demands of ICD- 10’s much more detailed terminology. One is a computer-assisted coding (CAC) software provided by Optum. CAC software utilizes electronic physician documentation (including dictation) and natural language processing technologies to generate codes from the content of notes. A human coder must still verify and validate the results of CAC, but coders are able to deal with the increased complexity without dramatically increasing workload. To help physicians provide enough specificity in their diagnoses to support coding as well as list the correct diagnoses and problems, Cerner provides an application called Diagnosis Assistant (DA) which will be installed within power chart prior to October. DA will provide a structured format to help the physician choose diagnoses by prompting for things such as site, laterality and other requirements for ICD-10 terminology.
A key component to any remediation effort is education: coder education, provider education and associate education. To support these educational efforts, we’re contracting with a vendor called Precyse University and adopting a new provider Learning Management System (LMS) called Healthstream. This will allow our providers and staff to access any of these educational modules from anywhere, at any time, and from any device (including iPhone or Android phones) — not just for education before go-live, but for support after. There will be selected on-site classes as well. There is an added benefit of adopting this LMS. We’ll be pushing all of our IT education to this platform. All the IT courses, hot sheets, short videos and other tools will be either assigned or archived and will be searchable. We’ve never had that type of functionality for our physicians before, and plan to take full advantage of it beyond ICD-10 content.
