North Bay health care responds to Oct. 1 big medical records change

In a major overhaul of the hospital and health care coding system in the U.S., a new version of diagnosis and inpatient coding is about to be implemented for the first time in 36 years.

After several delays over the past years, the federal mandate was finally made effective Oct. 1.

The International Classification of Diseases, 10th Revision (ICD-10), is a revision of the ICD-9 system which physicians and other providers currently use to code all diagnoses, symptoms, and procedures recorded in hospitals and physician practices.

ICD-10 has more than 68,000 diagnostic codes, compared with the roughly 13,000 found in ICD-9. The revision also includes twice as many categories, and is much more specific in identifying treatment.

“The challenge for doctors is that there is so much more specificity needed now with what they find, and the diagnosis. The doctor’s job is focused on documentation,” said Richard Carvolth, chief medical officer for St. Joseph Health in Sonoma County.

As an example, a diagnosis documented with ICD-9 might read, “Patient had right hip fracture.” In the new coding system, there might be 12 specific kinds of right hip fractures a doctor can diagnose from.

The benefit of the new, more explicit coding will be much more accuracy in collecting data about diseases and disease process. For example, with the many types of heart disease, new, more specific documentation will provide better detail.

“This will give us a much better opportunity to evaluate causes and outcomes with success and to improve care,” Carvolth said. “It will allow us to participate on more global data with impact.”

The U.S. has been operating with ICD-9 since 1979. The World Health Organization finished ICD-10 in 1992. Most industrialized countries adopted ICD-10 during the 1990s, beginning with Australia.

Planning for the transition at St. Joseph Health in Sonoma started several years ago. James Kennedy, certified in codes and an ICD-10 expert, was contracted to educate physicians at each of their facilities. Physicians have received multiple levels of education tailored to their specialty. In anticipation of the changeover, St. Joe’s also upgraded their information system and electronic health records in 2014.

“Three has been on-going training with a large team and a lot of resources,” said Lori Hickey, regional ICD-10 provider specialist, contracted with St. Joe’s corporate office.

For patients, any impact the new codes may have for them will most likely be seen in billing. The intent of the new system is to enhance accurate payment for services rendered, and any issue will be between the codes that are submitted and the insurance company, which might cause payment delays.

“No one can memorize 68,000 codes,” Hickey said. “The impact on billing for patients will be depending how the insurance company handles it.”

Both Hickey and Carvolth stressed the amount and levels of education physicians and coders have received, and the resources available for support. St. Joe’s also has a user-friendly software package on the new system from 3M.

As might be imagined, this is a huge overhaul and some are not prepared to convert to the new system.

A quick survey of other area health care systems and facilities that are prepared for the Oct. 1 deadline include Sutter Health, Kaiser Permanente, NorthBay Healthcare and Marin General Hospital.

“For the past three years, Kaiser Permanente has been preparing for this significant change and that has meant the training of hundreds of staff across Northern California, and also preparing our systems to accept the new code,” Kaiser said in a statement. “We are ready to begin using the code on Oct. 1.”

According to the Workgroup for Electronic Data Interchange, a nonprofit health care industry trade group that promotes computerization in health care, only 21 states have adopted the Oct. 1 deadline.

Medicaid programs in California will not be fully converting to the new system, as nearly everyone else is federally mandated to do. Instead, they have received approval from the Centers for Medicare & Medicaid Services to take incoming claims coded in the new ICD-10 system and convert them into ICD-9 codes, and use the older system to calculate payments to healthcare providers.

The change to ICD-10 does not affect CPT (current procedural terminology) coding for outpatient procedures, or to state workers’ comp programs.