A recent article from The Wall Street Journal on the government-mandated switch from the ICD-9 coding system used by medical coders and billers for diagnosis and procedures to the newer ICD-10 system caught the attention of Wendy Whittington, M.D.Wittington, the chief medical officer at the Dallas-based Anthelio Healthcare Solutions, saw that the writer of the article was trying to be funny. It poked fun at the complexity of the ICD-10 code set, which features more than 155,000 codes. There are codes for seemingly everything and anything, including an extensive list of codes for injuries in an opera house.Yet despite the humor of this article (title: “Walked Into A Lamppost? Hurt While Crotecheting? Help Is on the Way”), Wittington doesn’t think the switch from ICD-9 to ICD-10 is a laughing matter in the grand scheme of things.While some may see the ICD-9 to ICD-10 mandate as another compliance nuisance for physicians and doctors, she says this switch is truly necessary.“It’s not that the others aren’t necessary,” Whittington says. “But we’re currently using a system that was put into effect in the 1970s, during an era when healthcare was very different than it is today. This coding system is what we rely on to be able to translate what we as physicians do into terms that go out to the rest of the world, and particularly to the payers.”Without a proper translation of an ICD code, Whittington says she is not able to tell the story of what she has done for patients. Because of numerous advancements in medicine and surgical procedures over the past 30 years, the ICD-9 code set does not always have a code that aptly describes what she is doing.“We have surgical procedures now that no one dreamed was possible in the 1970s,” Whittington says. “We’ve gone from needing a scar that covers half of your body to taking your gallbladder out. There are so many more procedures and we don’t have the codes to describe those.”Whittington says there’s no way to capture how disease is processed in ICD-9, a critical component of today’s healthcare system. The updated code set would also help the U.S. enter an era of evidence-based medicine, where comparative effective research is taken more seriously. Essentially, ICD-10 will allow physicians to compare patient to patient more effectively.The critiques on ICD-10’s granularity aren’t valid according to Whittington. She says some of the codes may be silly, as the Journal pointed out, but none of them get in the way.“As a physician, I don’t care and have nothing to lose that there’s a code for walking into a lamppost. It will never get in my way. We have a lot more to gain by that tremendous granularity if we do things correctly,” she states.In Whittington’s view, there is no good reason for why the switch to ICD-10 has been delayed. The U.S. remains one of the last developed countries to adopt the code set, which has been ready for use since 1998. All of Europe as well as Canada and Australia are already on ICD-10.“I think it’s an embarrassment personally that we are on ICD-9,” Whittington says. “When people say it’s going to be delayed again, I know why they say that, because it’s been delayed so many times. In my opinion, it’s inexcusable.”
Wendy Whittington, M.D.If there are no delays this time around, then on Oct. 1, 2013, the U.S. medical community will officially be on the ICD-10 system. However, not every hospital or healthcare provider may be ready for that date.“When the government announced the deadline for ICD-10 was in October of 2013, there was plenty of time,” Whittington says. “What has happened, a lot of hospitals and healthcare providers have ignored it or put it on the backburner because they are too busy with meaningful use requirements. It’s really coming down to the wire.”If a hospital hasn’t taken the ICD-10 switchover seriously already then it’s probably too late to make the deadline says Whittington. However, she has a few tips for organizations looking to start up the process. She urges healthcare IT leaders to ensure the following:
- Organization-wide awareness: Everyone across healthcare, not just IT, needs to be on board.
- Physician preparedness: Physicians need to start documenting the care they are providing in a more specific way. This will allow for easier coding on ICD-10 when it comes time for implementation.
- Inventory: Finding out where ICD-9 codes are used across the hospital.
Given the right approach, she believes, healthcare IT leaders who take these steps should find success in making an important—and serious—transition.
