Next time someone is injured after being struck by an orca or receives burns from water-skis that are on fire, health care providers will have the appropriate medical codes to bill insurers for treatment.
And public health organizations can now accurately track the number of injuries caused by people being sucked into jet engines and accidents while people are knitting.
That’s because this month, the U.S. began using the International Classification of Diseases, 10th revision, known as ICD-10, which is a list of medical situations maintained by the World Health Organization.
While the new medical code set includes plenty of humorous codes for obscure injuries, it also includes thousands of codes for diseases and procedures that didn’t exist when the last version was created. The newer version will allow for more-specific diagnoses, better tracking of health outcomes and improved disease monitoring worldwide, according to health officials.
The previous set of codes, ICD-9, had been in place since 1979. While other industrialized countries transitioned to ICD-10 after its approval in the ’90s, the U.S. continued to use the older version.
“A lot of the procedures we do today were not even dreamed about back then,” said Wayne Johnson, PeaceHealth’s ICD-10 project director. “The code set was pretty antiquated.”
Used for billing
ICD-10 includes diagnostic coding used in all health care settings and inpatient procedure coding used in hospitals. In addition to being used to track diseases and diagnoses, the codes are also used for insurance billing in the U.S.
ICD-10 has 69,823 diagnostic codes, up from 14,025 in ICD-9, and 71,924 procedure codes, up from 3,824.
Two specialties where ICD-10 has made the biggest impact are cardiovascular services and orthopedics, Johnson said.
ICD-10 allows providers to record more-specific details of a visit and diagnosis, and better document the course of treatment, he said.
Take a person with a wrist fracture, for example.
With ICD-9, the injury would simply be coded as “wrist fracture,” said Courtney Lakin, Legacy Health’s ICD-10 program manager. An ICD-10 code, however, identifies the right or left wrist, whether it’s an open or closed wound, and whether the fracture is healing normally or delayed, among other details.
Another example of the increased specificity is with diabetes diagnoses.
“In the ICD-9 world, we were only tracking diabetes in general aspects,” Lakin said. “In the new ICD-10 world, we’re tracking Type 1 and Type 2 diabetes.”
Distinguishing between the two types will offer providers, organizations and researchers more-specific information about patient outcomes based on the type of diabetes, Lakin said.
The new code set also includes diseases — Ebola, for example — that weren’t included in ICD-9. That, Johnson said, allows for better worldwide disease tracking and monitoring.
“We were missing data and opportunities for tracking,” he said.
The change comes with uncertainties, though.
For starters, providers are unsure how payers will handle the extra complexity, said Dr. Marcia Sparling, The Vancouver Clinic’s medical director for operations and information technology.
If a provider sees and treats a patient for a right elbow problem and the patient later has a left elbow problem, it’s unclear whether payers will consider that a new ailment or a continuation of treatment, Sparling said.
In addition, many of the payers rely on computer programs that link medications and covered treatments to specific ailments and diseases. If every new cluster of codes isn’t correctly linked, that could result in denied, or delayed, claims and payments, Sparling said.
“It’s a little unnerving,” she said.
Delayed by a year
ICD-10 went live Oct. 1, but many organizations were preparing for the switch more than a year ago. The change had been scheduled for last October but was delayed a year.
PeaceHealth began using the ICD-10 terminology last year, giving providers time to get used to the new codes before the change was required. PeaceHealth reviewed thousands of software applications to determine which needed upgrading, and began rolling out the new systems, Johnson said.
“By doing that in advance, it’s less disruptive to the clinicians’ work flow,” he said.
Legacy has been planning for the change since 2011. The preparations involved numerous departments — including IT, revenue cycle, providers, finance, marketing and communications — and subcommittees formed to focus on different aspects, said Terrie Handy, Legacy Health’s vice president of revenue cycle operations.
For more than a year, Legacy dual-coded all inpatient claims, using both ICD-9 and ICD-10 codes, to get familiar with the new codes and test the process, Handy said.
The Vancouver Clinic also spent the last year and a half dual-coding to help everyone prepare, Sparling said.
Time will tell whether the new codes will cause hiccups in the billing process, but leaders at the local organizations said they felt prepared.
“This is the first time in health care, at least in my 14 years of experience, that we had a lot of providers, payers and clearinghouses partner together for one goal at the same time,” Lakin said.
