Linda Reed, the CIO at Atlantic Health, one of the largest nonprofit health care systems in New Jersey, is hoping today's changeover to the new ICD-10 medical coding system will be like Y2K -- all build up, no catastrophe.
"We know there will be issues. We're thinking we'll see them next week," Reed said, referring to when insurance companies will begin approving or denying medical treatments based on the new codes. "There are just so many moving parts."
After two major deadline extensions, the new, vastly expanded ICD-10 medical classification list went live today, affecting every U.S. healthcare provider and insurance company.
The diagnostic list contained in ICD-10, which increases the number of descriptive codes from 14,000 in ICD-9 to 68,000, forced facilities to upgrade and expand databases, add data storage and memory and increase staff.
The expanded codes cover descriptions for diseases, symptoms, abnormal findings, patient complaints, causes of injury or diseases and even social circumstances.
Some of the diagnostic codes can be archaic or absurd. Code Z63.1, for example, describes "Problems in relationship with in-laws," and code V97.33XD covers patients who were "sucked into a jet engine."
The codes, however, offer a far more accurate way to describe old and new diagnoses, diseases and medical procedures. In fact, the U.S. is vastly behind the curve in deploying ICD-10, a list created by the World Health Organization in 1993. The Czech Republic adopted it in 1994. Canada rolled it out in 2001. China adopted it in 2002.
"Other countries are starting to look at ICD-11 at this point," said Matthew Winestock, a spokesman for the College of Healthcare Information Management Executives (CHIME).
The new ICD-10 codes will dictate how the more than $2.8 trillion that Americans spend each year on medical care is paid out.
In August, a survey by the nonprofit Work Group for Electronic Data Exchange revealed that 90% of hospital respondents believed they were ready for the Oct. 1 transition.
"Anecdotally, what we hear is hospitals and their CIOs feel they're ready," Winestock said.
Hospitals, physician practices and other care facilities have been forced to add both full time and temporary personnel to ensure the correct codes are applied so insurance companies can appropriately bill for treatment.
Atlantic Health contracted a third-party company to help add the new codes to physician diagnosis and treatment and prescription orders.
Healthcare facilities have upgraded and expanded databases, and increased data storage systems and computer memory. There are separate inpatient and outpatient billing systems and ancillary billing systems used by individual departments, from radiology and labs to pharmacies that all must reflect the new ICD-10 coding system. Electronic medical records (EMRs) must be ICD-10 compliant as well.
Atlantic Health opened an ICD-10 "command center" yesterday to handle what it expects will be a flood of inquiries about the new codes.
"We have an army of people at the pre-registration department, so when patients come in, our top priority is to make sure they get their services," Reed said. "Everybody is armed with a cell phone so they can help patients call their physicians offices so they can get their codes."
Prior to going live today, Atlantic Health went through four application upgrades to database systems and many smaller software patches by vendors, the last of which occurred at midnight yesterday, Reed said.
Physicians and nurses went through training early in the process to become familiar with the new coding system.
But it's not the hospital's staff that concerns Reed at this point. "Our other concern is that there are payers who will not be ready. We already know Medicaid said they're not ready," she said.
Because the coding system is being implemented on a Thursday, close to a weekend, it will likely take until early next week to see how payers respond to billing with the new codes, Reed said.
Most hospitals and health systems have spent the last several months doing end-to-end testing with their payer partners and working to iron out any glitches. Additionally, they've spent countless hours training physicians and coders on the intricacies of ICD-10.
During the weeks and months ahead, CIOs will closely monitor how the transition is going to ensure that their organizations are positioned to take full advantage of the benefits of the new coding system.
"Today it's the patient-facing stuff, ensuring we can get codes into our system and take care them," Reed said.
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