More than 17,000 codes are used to classify diseases, injuries and procedures in the health care industry nationally, but some say the system is in need of expansion.
“It is really outdated,” said Angie Comfortcq TM, director of excellence with the American Health Information Management Association. “It doesn’t actually track or identify new clinical services that weren’t available in the 1970s.”
The World Health Organization approves the publishing of the codes known as the International Classification of Diseases, or ICD. The United States has been using the classification’s ninth revision, or ICD-9, since 1979. The organization approved the 10th version, or ICD-10, in 1990 and the 11th version is being developed.
“We are the only industrial country that has not transitioned to ICD-10,” Comfort said.
For example the United Kingdom started using the newest revision in 1995, France in 1997, Germany in 2000 and Canada in 2001, Comfort said.
The U.S. Department of Health and Human Services issued a final rule in 2012 mandating that the health care industry update to ICD-10 by Oct. 1. However, on April 1, the Protecting Access to Medicare Act was passed, delaying the update to no sooner than Oct. 1, 2015. According to the Department of Health and Human Services, a new date for compliance will be set in the near future.
Health care officials nationally and in Arkansas have said the transition will not be easy. The ICD-10 revision will expand more than 14,000 diagnosis codes to about 69,000, according to the Centers for Disease Control and Prevention website. It states that codes specifically for procedures will expand from nearly 4,000 to nearly 72,000.
Comfort said those who use the codes, including doctors, nurses, medical coders, insurance companies and researchers, will need to be retrained. In many cases, computer systems will have to be updated to handle the expansion of the codes, she said.
For example, there is one code in ICD-9 for the diagnosis of rheumatoid arthritis. In ICD-10, there are 96 codes that could be used because the ICD-10 codes specify which body part the arthritis affects. Codes in ICD-10 also specify whether a diagnosis is on the right or left side of the body, something ICD-9 codes do not do.
A doctor diagnosing someone with rheumatoid arthritis after the transition to ICD-10 would need to be specific to the location of the arthritis in notes. Medical coders will then read the doctor’s documents and determine the correct ICD code.
A bill denoting the code then will be sent to a patient’s insurance company. The insurance company will respond to the claim based on rules it has regarding the specific code used.
Hospital transition
Paul Cunninghamcq TM, executive vice president for the Arkansas Hospital Association, said hospitals have been preparing for the transition for more than two years.
“It is going to be important that they get it right when they make the changeover,” Cunningham said. “Once you switch over, if you don’t have everything ready to go and you submit a claim and it is not done correctly, then that claim will not be covered.”
Errors in coding will eventually be resolved, but that could take time, Cunningham said.
“We look at it as a potential cash flow problem,” Cunningham said. “It could slow down the time between when a claim is submitted and the time that payment comes in.”
Angela Johnson,cq TM director of health information management at University of Arkansas for Medical Sciences, said medical coders at the hospital have gone through extensive training to prepare for the transition.
“All of our coders went through a year of training,” Johnson said.
Training included taking medical classes on topics such as anatomy, Johnson said. Another class focused specifically on ICD-10 codes. As the transition nears, the coders will be asked to code everything in both ICD-9 and ICD-10 to prepare, she said.
However, Johnson said, doctors also must be trained on taking notes. Researchers throughout the institution also have to learn how to use the new codes.
“We have different code sets,” Johnson said. “So how are we going to compare ICD-9 to ICD-10? That is going to be a challenge for everyone who uses statistical data.”
The change could be difficult for researchers, but it will provide them more data over time, Johnson said.
“The whole reason for the change is because we need more robust data,” Johnson said.
The CDC’s website states that ICD codes are important to morbidity data. The codes are used to track public health conditions, epidemiological research and care outcomes, the website states. The transition to ICD-10 will provide better data because it is more specific in identifying health conditions.
Insurance companies
Insurance companies also will have to adapt.
It will take years for health care providers and insurance companies to transition fully, said Joseph Smithcq TM, a spokesman for Arkansas Blue Cross and Blue Shield.
Insurance plan language is written around ICD-9 codes, Smith said. Arkansas Blue Cross and Blue Shield will intake claims using the ICD-10 code system but will convert them back to ICD-9 to know how to cover treatment, he said.
After years of research on diagnoses specific to ICD-10, the insurance company could start changing its coverage to meet the codes, he said. For example, rheumatoid arthritis in the hip could cost more than arthritis in the left pinkie, Smith said.
“The possibility of outcomes could be nothing for the patient or it could be that, under certain circumstances, something that used to be paid is now denied,” Smith said. “Or it could be something that was not covered becomes covered. Generally the patient is not going to see a whole lot of difference.”
Over time the new codes will help insurance companies find abuse or fraud in claims, Smith said. The more specific information will make it easier to see patterns, he said. One simple example would be that someone couldn’t amputate his left arm twice, he said.
Smith said insurance companies will have to invest in the transition.
The organization America’s Health Insurance Plans estimates that insurance companies will spend between $99 million to $1.7 billion transitioning to ICD-10. Costs will vary depending on the size of the company.
Comfort said ICD-10 codes ultimately will provide smoother sharing of information about patients. This could help patients who see several specialists or change doctors, she said.
The transition also will help the country understand and treat injuries and disease, Comfort said. Better data will help research advance health care, she said.