Deborah Grider wrote the book on ICD-10 implementation. Actually, she wrote three books on it:
- Preparing for ICD-10-CM: Make the Transition Manageable
- Principles of ICD-10-CM Coding
- Principles of ICD-10-CM Coding Workbook
Now she's a senior manager at Blue & Co. working with rural and small hospital systems as their ICD-10 project manager.
"I don't know how we'll get there by Oct. 1, 2013," she said of ICD-10 readiness. "We still have so much work to do."
To her a year delay sounds about right to reach compliance without encouraging procrastination.
Part of the problem is that hospitals and physician groups owned by hospitals have many systems that need upgrading.
"We went into one physician practice that was hospital-owned, and they have three systems that aren't integrated. And one of them is not going to be ICD-10 ready because they decided not to," she said to illustrate the problem.
Not only do they plan on replacing that system with an ICD-10 compatible one, but they're looking for a solution that integrates all the systems into one. As it is, the physician group is entering data into three different systems.
Documentation is another challenge. "We're finding the documentation's not going to be sufficient," she said. "So we need to spend more time with those physicians, getting them ready to document for ICD-10."
Working with the physicians to change their documentation habits will be a challenge. "That takes time: changing their patterns; changing their mindset; getting physicians to buy into this," she explained.
But the medical coders won't be such a challenge. "I think the coders are going to be ready. That's an easy transition."
The unspecified challenge
"The point of moving to ICD-10 is specificity," said Grider. But she's concerned that systems aren't going to produce the most specific diagnosis or procedure code possible. For example, some vendors have electronic medical records that aren't built to capture all the specificity possible.
She added, "What I'm finding is that some of the EMR systems don't have algorithms built into them where you can drill down to the more specific codes. So my fear is what they're going to do is select unspecified codes."
It's an issue that she has also found in hospital IT departments. She has a story about one that mapped its most-used diagnosis codes to ICD-10 codes. Since most of the current codes are unspecified, they matched up one-to-one. "They thought they didn't have any challenges moving from I-9 to I-10," she said.
But that ignores all the possible ICD-10 codes that could be used on medical claims. "When you're using these GEM files and these translator tools they need to look at all the possibilities."
So what's the point of ICD-10 coding? In the debates, there are always promises of opportunity in the increased specificity. Which is something that healthcare payers and government auditors are going to expect to find.