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One-year delay in ICD-10 seen helping more hospitals convert to the new coding system

April 16, 2012
Hospital and health system leaders welcomed the Department of Health and Human Services’ (HHS) announcement last week of a one-year delay in implementing the International Classification of Diseases, 10th Edition (ICD-10) for administrative health care transactions.

The department proposed setting the compliance date for Oct. 1, 2014.

“It’s good that we now have a target date; what we had for the past three months was a lot of uncertainty,” said Albert Oriol, Rady Children’s Hospital’s vice
president and chief information officer in San Diego. He described his hospital’s ICD-10 efforts as “well on their way.”

Oriol said the new date will allow the hospital to reassess its efforts and determine what areas of the project should be slowed down and what should continue as originally planned. For example, he said training for coders would likely be pushed back so it would take “place closer to when the new codes are going to be used.”

HHS announced in February a delay in the deadline for the start of ICD-10, but it did not specify the length of the delay.

In a proposed rule released on
April 9, the agency announced that the new Oct. 1, 2014 compliance date would apply to both diagnosis and procedure (ICD-10-CM and ICD-10-PCS) codes.

Many hospitals and other providers had called for a delay in the Oct. 1, 2013 start date.

They cited the many other technology- related, regulatory and reporting projects also under way at their organizations, including the rollout of electronic health record systems to participate in financial incentive programs for the adoption of meaningful use of health information technology.

“Hospitals have been preparing for the transition to ICD-10 for a number of years because it will allow for better patient quality through improved health technology and data collection,” said Chantal Worzala, AHA director of policy. “However, given the many competing initiatives, the one-year delay will allow hospitals, especially smaller ones, more time to complete the move to ICD-10. The AHA will continue to work closely with all of our members to support ICD-10 implementation.”

In a recent AHA survey to assess ICD-10 readiness, 70% of the nearly 1,000 responding hospitals thought a short delay in compliance would be helpful, with the majority favoring a delay of no more than 12 months (see the tables on this page).

Bill Spooner, Sharp Health-Care’s senior vice president and chief information officer in San Diego, said the one-year delay “would give us an extra bit of breathing room” to complete the move to ICD-10.

Sharp HealthCare is an integrated regional delivery system that includes four acute-care hospitals, three specialty hospitals, two affiliated medical groups and a health plan. It began serious planning for the transition to ICD-10 two years ago.

Spooner helped lead the system’s efforts to address transition issues, including applications, payers, provider affiliates, education and finance. Spooner said they identified about 60 computer systems-related issues that needed to be resolved. “Our biggest challenge initially was getting our arms around the size of the project – this is really huge,” he said.

Sharp HealthCare spent considerable time and resources in identifying for physicians and coders tools such as speech recognition software, computerassisted coding and controlled medical vocabularies that it hopes will improve documentation.

“The way that we are going to be most successful is if we have the physicians on board,” Spooner said. “We have to be able to collaborate with them.”

HHS in 2009 released a rule calling for adoption of ICD-10 to update the nation’s 33-yearold clinical coding system.

Providers now use ICD-9 code sets. ICD-9 can accommodate about 17,000 codes, while ICD-10 has space for more than 155,000 codes.

“The additional specificity that ICD-10 will allow is very welcome,” said Cindy Hutchinson, director of HIM Coding Services for Salt Lake Citybased Intermountain Healthcare. “We believe that it will also equate to better quality of care.

With the level of specificity that is allowed with ICD-10 it may be easier to identify disease management needs and/or tailor disease management programs.” Intermountain Healthcare, which includes 22 hospitals, more than 185 clinics, an 800 doctor medical group and one of Utah’s largest health insurance plans, began planning its transition to ICD-10 in 2008 and formalized its ICD-10 Migration Program in 2010. An executive steering committee created 20 workgroups and support teams consisting of about 300 employees. Some of its biggest challenges include quantifying the budget necessary to transform the entire organization to ICD-10, competing priorities in the technical arena, identifying strategies for physician engagement, and deciding on the timing and methods for training physicians and coders.

Before HHS’ announcement of the delay, Intermountain Healthcare was preparing to meet the Oct. 1, 2013 compliance date. But Hutchinson said if there was a delay the health system would adjust dates and “fill additional time with further research and solidify strategies.” She also said the health system would “appreciate the advantage of the delay that could provide for technology and testing.”

The proposed rule, which also includes several changes under the “Health Insurance Portability and Accountability Act,” was published in the April 14 Federal Register with comments accepted for 30 days. To view the rule, visit http://www.ofr.gov/OFRUpload/OFRData/2012-08718_PI.pdf.

By Pete Davis