Editorial By Katrina Miller, MD 
Hi everyone! Please allow me to introduce myself as the new Secretary-Treasurer for the Los Angeles Academy of Family Physicians. My name is Katrina Miller and after residency at UCLA and working at USC, I have been working with Adventist Health for the past few years as Faculty in the Residency program and now for the last two years, as Clinical Information Systems Medical Director for Adventist Health West. AH is comprised of nineteen hospitals and more than 100 clinics, all now live with CPOE and attesting to Meaningful Use 1 and now, 2.
As the Affordable Care Act and HealthCare.gov is waning from the headlines, and Meaningful Use is under way for anyone who will attest, it is time to look forward to that special date of October 1, 2014 when our beloved ICD-9 (International Classification of Diseases, version 9) will transition to the behemoth of ICD-10. Approximately 18,000 numeric 3-5 digit codes that the US has been using for decades now will transition to approximately 140,000 codes with up to 7 alphanumeric digits leading to such memorable codes as, “S82.209A” instead of “823.20” for “closed fracture of the tibia”. Even better are the codes for procedures, such as 0FB03ZX for a diagnostic liver biopsy. ICD-10 does support more specific descriptions for disease and procedures that will hopefully help with better analysis of these medical scenarios and improve appropriate reimbursement.
The coding system that the rest of the world has been using for years will come home to roost 10/1/14. You may recall that this date was pushed back from 10/1/13, when the US healthcare industry determined there was no way this could happen on that date, but this date won’t change again.
So get ready my friends. This is a complex transition that will require preparation and training by providers, coders, quality managers, administrators and more. It is not to be trifled with. Recently, I saw this message regarding our internal transition that caused to me to sit and think for about five minutes just to understand it,
“The CCD generation service attempts to cross-map an ICD code to SNOMED CT, but there is not 100% coverage for ICD-9 to SNOMED CT cross-mappings and Cerner has not received ICD-10 to SNOMED CT cross-mappings from any source.”
Yowzers.
I am sure that all of you in your offices, or hospitals, in your administrative and executive meetings, and in your committees or training programs are already figuring out what to do. Here is a little run-down of what we are doing in case it helps anyone out there:
1. Financial Impact Assessment on claims. This will help identify the high risk, high dollar, high volume claims that will be ICD-10 documentation improvement opportunities. Check with your EHR vendor and local coding or financial staff and see how they can help.
2. Use electronic documentation. Most EHR systems as well as third party vendors have, or will be releasing applications using Natural Language Processing (NLP) which can detect certain keywords to aid in the development of an ICD-10 code. If your site is scanning paper records, this will likely not work. Encourage as much of your staff as possible to document through electronic notes or dictation.
3. Educate coders and Clinical Documentation Improvement Specialists (CDIs) and get them certified in ICD-10 as soon as possible. These folks will be the backbone to coding and reimbursement. It will be advantageous to get them as comfortable as possible with ICD-10 as quickly as possible so they can start coding using both systems for practice. The American Health Information Management Association (AHIMA) can help with this. http://www.ahima.org/icd10/
4. Become familiar with how ICD-10 will impact you. You know the codes you use now, look them up and see what the ICD-10 version is. If your site has already set up a double system for using ICD-10, get familiar using that. Use whatever training materials come your way from your site, EHR or professional societies.
Here is the Center for Medicare and Medicaid Services (CMS) link for more information.
And here is a Medscape CME activity for “A Roadmap for Small Clinical Practices”.
As CMS says, “The responsibility lies with providers to comply with the deadline for use of ICD-10.” It is up to us to get prepared and be ready for this next monumental transition in our healthcare industry. We, as family physicians have a unique and important responsibility in this process. We are the primary care physicians determining these codes correctly when we see our patients in the office more than any of our consultants do. We are the hospitalists who admit these patients and need these codes to be correct for DRG analysis for the hospital and payors. And we in family medicine stay informed about these medico-legal issues and can present them for discussion in our department and medical staff or medical executive committees so that our institutions don’t fall behind as this time draws near for this conversion.
So good luck to you and to us. But keep in mind that luck is where preparedness meets opportunity, and this opportunity is a must on October 1, 2014. Mark off the time, educate yourself and your staff, and anyone who will listen. And then perhaps with all we do to prepare, this will be like the “Millennium Bug” that ended “not with a bang, but a whimper.”
“Yes, our teeth and ambitions are bared
Be prepared!”
Take Care everyone! -KM
For updates on all your coding and payment needs, please go to CAFP’s website.
