June 24, 2015
By Greg Peters
Remember the Y2K scare, when many feared computers were going to fail, entire electrical grids were going to die and life as we knew it was going to come to an end on January 1, 2000?
The health care industry in the United States is facing a similar concern, and its name is ICD-10, or the 10th revision of the International Classification of Diseases (ICD). ICD is the coding used by the health care industry for everything from billing and tracking diseases, to prescribing medications. Oct. 1, 2015, is the day when the entire country must make the conversion.
Judy Bielby, a clinical assistant professor in the Department of Health Information Management at the University of Kansas Medical Center, is an expert trainer on the two versions of ICD-10 - ICD-10CM and ICD-10PCS - that will be implemented in the United States. Bielby hopes that, much like the Y2K scare, the conversion will be much ado about nothing.
"Everybody was so concerned about Y2K and worked so hard on it, that it went off without a hitch," Bielby said. "I think we've got enough vendors and payers ready that we can kind of get everybody else worked through the transition."
The origins of ICD
Published by the World Health Organization, ICD is the most widely used statistical classification of diseases in the world, with origins dating back as far as the late 1800s. Bielby said the conversion to ICD-9 in the 1970s was much simpler since it primarily involved training coders, and there was no concern about updating computer systems and making sure interfaces worked. Work on ICD-10 began in 1983, and much of the world has already begun using it.
While many people support the conversion, the coding system is not without its detractors. Implementation of ICD-10 has been delayed three times in the past few years for a variety of reasons. Initially, there was pushback from many industries and stakeholders, but most have come onboard and are anxious to get started.
The biggest resistance has come from doctors. Bielby is quick to point that she has worked with many physicians to create tools to ease the transition and said many are excited about ICD-10. But there are some doctors - especially in smaller practices - who have voiced opposition, particularly about the cost of the conversion, and that pushback has even found its way to Congress.
But the delays are not without costs. Cassi Birnbaum, president of the American Health Information Management Association and a University of Kansas alumna, estimated each year the implementation has been delayed has resulted in a cost of between $8 billion and $12 billion.
"Unfortunately, there have been a lot of obstacles along the way to implementation of ICD-10," she said during a recent visit to KU Medical Center. "At this point, we have given free tools and educational materials to small practice physicians, and there really isn't any excuse for anyone not to be ready."
In Scott City
Haley Burgess, a May graduate of KU's Department of Health Information Management, was doing a management internship this spring in Scott City, the southwest Kansas town where she grew up, when the chief physician officer tasked her with helping Scott County Hospital get ready for ICD-10. Burgess developed implementation plans for Scott County Hospital and its Rural Health Clinic.
Like many health care providers, the hospital had done a good job of preparing for the conversion before the delay, but now faces the task of making sure everyone is properly trained before Oct. 1. Burgess's main goal was to get a plan in place so that there won't be any unexpected bumps in the road.
"Absolutely, it was my impression that everyone was aware that there are going to be some major changes," said Burgess, who was offered a job at the hospital after her internship in order to help with the transition. "Scott County Hospital had great buy-in from stakeholders and its medical staff, which will make this transition much easier."
What will happen on Oct. 1?
So what will the conversion to ICD-10 mean to most users? Hopefully, much like Y2K, there won't be much difficulty in the transition. For patients, the changeover should be seamless, although there could be some delays in billing and payments, and they might see some codes on their explanation of benefits that differ from prior statements.
For most doctors working in hospitals or larger practices, life will remain pretty much as is. The biggest differences will come for medical coders, people dealing with billing and those who work in small medical practices where everyone has to share the workload. Some experienced administrators have codes they have memorized over the years, and now they will have to be looked up until they are more familiar with the new codes.
"For those who follow and understand the correct steps to coding, ICD-10 is not that different," said Bielby. "The process is the same. They're going to have to get used to looking up codes again, and that might slow them down a bit."
ICD-11 around the corner
Experts say the next generation of ICD is coming soon. It is predicted that the World Health Organization, which has been using ICD-10 for some time, will adopt ICD-11 as early as 2017, while in the United States ICD-11 could be as late as 2037. But Bielby is optimistic it will not take that long.
"I have a feeling it will be a little quicker this time around," she said. "I don't think there is going to be as much pushback. I think it will be much easier to get ICD-11 implemented than ICD-10."
You can learn more information about the implementation of ICD-10 – and some common myths about the changeover – in this video.