Physicians and Office Staff - Not Just Coders - Need to Prepare for ICD-10

Thea Campbell, (left) director of the Health Information Department, goes over the ICD-10 book with Jacqueline Soriano, coding manager for Health Information.

New System Requires Additional Information to Ensure Reimbursement

The deadline may be almost a year away, but the pressure is building to ensure that all physicians, surgeons and their staff members are familiar with the language of ICD-10, the new coding system that U.S. hospitals and insurance companies will be adopting in October 2014.

"This is a complex project with potential negative impact to reimbursement," said Steven Galen, MD, chief of staff. "The highest complexity for physicians will be adhering to the new documentation requirements."

Cedars-Sinai's Health Information Department is offering in-person ICD-10 training sessions for physicians and their staff members starting this October, said Thea Campbell, the department's director. As the 2014 deadline approaches, additional training sessions will be offered.

Campbell added that specialties such as orthopedics, obstetrics and cardiology will feel the impact of the change most strongly.

"Cardiology is hugely important as that is one of the areas in the new code sets which are going to require a lot of education," Campbell said. "Obstetrics is another because ICD-10 has an emphasis on trimesters."

ICD-10, the 10th revision of the World Health Organization's International Classification of Diseases, is used to track diseases and other health problems. Cedars-Sinai coders will begin using the new system in parallel with ICD-9 starting Oct. 1, 2013, to ensure they are ready when the official nationwide switch to ICD-10 occurs in 2014. Cedars-Sinai's Health Information Department also is working with private commercial payers to compare claims coded under ICD-10 for analysis purposes, Campbell said.

There are significant differences between the two coding systems. Under ICD-9, an appendectomy was coded as just an appendectomy. ICD-10's more sophisticated coding requires specifying the process involved in removing the appendix. The characters within ICD-10 procedure codes refer, in sequence, to the body system involved in the procedure, the underlying objective of the procedure, the body parts involved, the surgical approach, any devices used and an anatomic qualifier. Some codes require a seventh character, whose meaning can change.

"You are basically identifying what part of the body is being resected as well as the approach," said David Landry, an experienced coder specialist at Cedars-Sinai.

The new coding system also is designed to accommodate new conditions and procedures as they are recognized and developed. Such changes were limited in ICD-9 coding, Landry said.

All of the world's industrialized nations, except the United States, switched from ICD-9 to ICD-10 in the 1990s. It wasn't until 2009 that the United States announced it would transition to the new system. The start date had been set for Oct. 1 of this year, but was postponed to 2014 due to nationwide concerns over implementation, said Jennifer Esterbrooks, who is in charge of ICD-10 education and training at Cedars-Sinai.

With the time remaining, Cedars-Sinai is taking steps to encourage its coders, medical staff and private physicians to prepare for the upcoming transition.

"Our intent is to identify impact on users, training required and high-risk areas needing attention," Esterbrooks said. "If we can generate dialogue and feedback early, then we will be well prepared for a successful go-live next year. That's our goal."

For more information, or if you have a question about ICD-10, please e-mail askICD10@cshs.org.