Hit by a turtle? Under new system being rolled out nationwide, there'll be a medical code for thatA fan of Duluth music who hears the phrase “Trampled by Turtles” might think of bluegrass music. A health data specialist might think: There’s a code for that.
By: John Lundy, Duluth News Tribune
A fan of Duluth music who hears the phrase “Trampled by Turtles” might think of bluegrass music.
A health data specialist might think: There’s a code for that.
The nation’s health-care system is undergoing a costly and long-delayed transition in the coding system for every conceivable medical condition, from a sprained ankle to the common cold to — yes — being trampled by turtles (“W5922XA: Struck by turtle, initial encounter”).
Everything you are treated for is assigned a code. The code determines how your insurance reimbursement is calculated. Codes also are used for obtaining medical data and for research purposes.
Since 1977, the U.S. coding system has been ICD-9-CM, which means “International Classification of Diseases, Ninth Revision, Clinical Modification.” But the rest of the industrialized world has long since made the transition to ICD-10, which the World Health Organization released in 1990. The U.S. version, ICD-10-CM, was scheduled to go into effect in 2008, and then postponed until Oct. 1, 2013. Within the past month, the Centers for Medicaid and Medicare Services announced a further delay for “certain entities,” said Ryan Sandefer, chairman for Health Informatics and Information at the College of St. Scholastica.
“Without identifying for how long or who,” added Brooke Palkie, an assistant professor in that department.
Health institutions are scrambling to make the transition. Duluth-based Essentia Health will get some help in that process, thanks to a $50,000 state grant. The grant will enable St. Scholastica to set up training for 70 Essentia personnel so they can prepare the rest of the staff, Sandefer said. Training begins June 1 and the grant runs for one year.
It’s a massive makeover. The existing coding system has 13,000 codes, according to an article published online this week in the journal Health Affairs. ICD-10-CM includes more than 68,000 codes. The inclusion of what Sandefer calls “bizarre codes” has spurred some tittering about ICD-10, particularly in a Sept. 13 Wall Street Journal article. That article also mentioned codes for “walked into lamppost,” “playing a brass instrument” and “burn due to water-skis on fire.”
Sandefer said he sees the humor in all of that, but he insisted the 10th Revision is a significant improvement over the ninth.
“The quality of information that’s going to be garnered from this transition is going to do a tremendous amount for quality of care in this country,” Sandefer said. “It’s going to provide data to be able to show what works and what doesn’t work so much.”
Palkie, who will lead the training, said the revised code will offer much more specific information, including what side of the body a condition occurred on, or which knuckle of which hand. That will give researchers a wealth of information they’ve lacked before.
“For just diabetes, I put together a grid, and it was three, four pages long of differences in ICD-9 versus ICD-10,” she said.
Some academics aren’t as enthused, including the authors of the Health Affairs article. “We contend that the ICD-10-CM conversion is expensive, arduous, disruptive and of limited direct clinical benefit,” wrote Christopher Chute, Stanley Huff, James Ferguson, James Walker and John Halamka.
The number of codes related to diseases only rose from 13,000 to 20,000, the authors note, meaning the percentage devoted to diseases dropped from 65 percent to 30 percent. “In fact, ICD-10-CM devotes a staggering 60 percent of its codes to injuries — including lamppost injuries — compared to 15 percent in ICD-9-CM,” they wrote.
There’s no disagreement that the process is expensive.
“I would say for large systems it’s in the millions of dollars,” Sandefer said.
Sandefer didn’t want to guess what it would cost Essentia, but he noted that the entire system has about 10,000 employees, and “ICD-10 touches about every single employee in some way.”
Sandefer and Palkie also agree with the Health Affair article’s authors that crunch time for the code transition is coming at a bad time for health institutions. That’s because they are also in the midst of a push to adopt what’s known as “meaningful use” in their electronic records systems. Hospitals and doctors have to demonstrate meaningful use to qualify for federal incentive money, and that effort is keeping information technology experts workers busy already.
The Health Affairs authors argued for further delay in implementing ICD-10, but Sandefer and Palkie said there’s a danger the U.S. will be left hopelessly behind.
“It’s important to implement this before the whole world transitions to ICD-11,” Palkie said.
The World Health Organization is expected to publish ICD-11 around 2016, the Health Affairs article said.
Although the grant runs through May 2013, Essentia hopes to have ICD-10 in place by that April, Sandefer said. Then it will practice dual coding until Oct. 1, or whenever the federal government ultimately decides to make the transition official.
The grant, which came from the Minnesota Department of Employment and Economic Development, was announced Feb. 29.
Does it seem significant that it was announced on Leap Day? Sandefer was asked.
“There’s probably a code for that,” he said.