By October 1st, US healthcare providers, insurers, and related businesses are expected to start using the new ICD-10 procedure and diagnostic codes for billing and health statistics purposes. I thought it was timely to send out a reminder and recap on this topic.
Background:
The ICD-10 conversion date had already been pushed out three times (2009, 2013, and 2014), but now it looks like it will really happen (with the possible exception of a 6 months transition period during which providers may be able to use both, the old ICD-9 codes or the new ICD-10 codes).
ICD codes (“International Statistical Classification of Diseases and Related Health Problems”; managed by the WHO) are used for various purposes, from classifying diseases and treatments over gathering data for health statistics to submitting bills to health insurances and Medicaid/Medicare. The ICD system has actually been around since 1893, back then it was called “International List of Causes of Deaths”.
ICD-9-CM is the main US version used to classify (and bill for) diagnosis and procedures and has been in use for 30 years. The transition to ICD-10 is a significant one since it not only changes the nomenclature and structure of the codes, but also adds much higher granularity (i.e. more codes for different diseases and stages). Hospitals will need to move from the old ICD-9 system of about 17,000 codes to the new ICD-10 with about 155,000 different codes. For example, “Angioplasty” is now 1170 different codes in ICD-10!
ICD-9 codes typically have the format of 3 digits followed by a period and an optional 2 digits, e.g. 123.12 (there are a few exceptional uses of letters). ICD-10 codes have a leading letter followed by two numbers and 4 alphanumeric extension characters.
Examples:
ICD-9 code "919.4 Insect Bite”
ICD-10 code “S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture”
Impact on our Customers:
The conversion to ICD-10 coding will affect pretty much every single IT system in the hospital, from patient registration over clinical documentation to billing. Healthcare customers should be well on their way with upgrading their main systems (EHR, billing, etc.) and training staff. I suspect that most providers are well on their way, but some may not and October is just around the corner.
One specific area of concern are “shadow systems”, things like personal spreadsheets or Access databases which people have developed for their own purposes, e.g. to support clinical research, or to bridge a specific data conversion step during the billing process. And any missed system that is overlooked in the conversion could jeopardize an important administrative or clinical process.
Here is how Symantec solutions can help:
- Our Endpoint Management Suite (Altiris) platform to discover software assets and licenses in use.
- Further, Altiris to support system conversion, software upgrades, staging, contract and license management.
(Note that often a simple application software upgrade may result in a platform or hardware upgrade, require data conversion, user account transfer, etc. – this is where the use of a tool like Altiris can really make a difference).
- Our Control Compliance Suite (CCS) or Workflow solution to manage upgrade projects, training, launch, etc.
- Data Loss Prevention (DLP) to discover “shadow systems” (e.g. personal spreadsheets) or “shadow processes” (e.g. emailing of ICD-9 codes).
(Note that ICD-9 codes are not very unique, so the search criteria would need to be customized and include groups of ICD-9 codes and/or the combination of code and descriptor).
- Data Insight to help understand who has ownership of unstructured data like spreadsheets on Fileshares, and to determine if these are actually still in use.
References:
General explanation: https://en.wikipedia.org/wiki/ICD-10
Comparison of ICD-9 and ICD-10 codes: https://www.unitypoint.org/waterloo/filesimages/for%20providers/icd9-icd10-differences.pdf
Best practices for managing conversion: http://www.ahima.org/icd10
Please feel free to reach out to myself or your Symantec Healthcare account manager if you want to discuss this further and understand how Symantec can help you in the final stage of the process.