Providers' Perceptions: ICD-10 Just the Tip of Hospitals' Coding Iceberg

One thing was clear at the recent AHIMA 2012 Convention & Exhibit: The transition to ICD-10 codes is still top of health information management professionals' minds despite the recent deadline pushback to Oct. 1, 2014. From the conversations Billian's HealthDATA had with providers on the show floor, HIM executives seem prepared to use this extra 12 months in one of two ways. Those, like Geisinger Health System in Pennsylvania, that have already set the wheels in motion to meet the original deadline in 2013 are continuing to move full-steam ahead, and are even pursuing early adoption requirements. Others, like Naples Community Health System in Florida, are taking the extra year to better align their transition to ICD-10 with a number of competing projects.

Geisinger's Path to Early Adoption
Geisinger, which serves more than 2.6 million residents in 44 counties, faces a unique set of opportunities and challenges when it comes to taking on ICD-10. It has been on an electronic medical record for the last 14 years, and has its own health plan, enabling it to better understand payment policies underlying the need to move from a set of 13,000 codes to more than 68,000. Like so many of its size, the health system is acquiring other hospitals and physician practices, and is concordantly migrating these new, sometimes paper-based, facilities to its current, electronic Epic system.

The HIM team had plans in place to meet the original deadline in 2013, and now are continuing on that path and evaluating early adoption, according to Sue Trewhella, RHIT, CPC, Associate Vice President of Revenue Management, Coding Operations, Clinical Documentation Improvement (CDI) and Compliance at Geisinger.

"We'll likely have a final decision on that sometime in December, so we haven't stopped anything," Trewhella explains. "We're moving forward with education. We've already got staff utilizing Precyse University [eLearning content from Precyse Solutions for all staff areas impacted by the ICD-10 transition] - I already have seven certified trainers on board. In my opinion, early adoption is a fabulous model. It brings learning to the table for physicians. If we teach them, now at a slower pace, what is expected of them [when it comes to dual coding], they will be where they need to be in their documentation practices by the time the ICD-10 team comes on board. I think that everyone understands that if we're going to see the benefit, we might as well start now."

Though the new deadline hasn't slowed down Geisinger's adoption plans for ICD-10, it has made Trewhella feel more confident that the system's vendor and payer partners will now have sufficient time to help Geisinger make the transition, especially in the areas of communication and testing.

When Trewhella and her team first began strategizing Geisinger's ICD-10 transition a few years ago, they realized they would need a vendor's help.

"We were interested in computer-assisted coding [CAC], front-end speech recognition, clinical data mining, all of these silos ... we were definitely looking for a vendor," she says. They ultimately decided to partner with Precyse and M*Modal to create a customized solution.

"Geisinger is really all about that," Trewhella says. "We take everything and customize it. We're so large that we need things to be accessible very quickly, so Precyse and M*Modal gave us that partnership, all in one bucket, which was absolutely critical."

Trewhella and her team, which to date includes 85 coders, have been working with Precyse and M*Modal for about a year to finalize their enterprise-wide, custom solution.

"We're getting ready to have a big implementation; everything is looking very positive," she says. "We'll have hospital full up on CDI. We'll have CAC up and running for both physician and hospital, and then we'll start rolling out individual areas very quickly after that."

Naples Community Health's Journey to 2014
A little over 1,200 miles south of Geisinger sits Naples Community Health System, which serves close to 33,000 patients via two anchor hospitals, 500 independent physicians, and additional medical facilities.

When the ICD-10 delay was announced, Naples staff were relieved, in large part due to the competing projects the IT and HIM departments were facing including implementing a new patient accounting system, transitioning to HIPAA 5010 transaction standards, and a goal of going paperless by July 2013.

"We really breathed an internal sigh of relief," explains Sandra Wood, MHSA, Operations Director, Revenue Cycle, at Naples. "Selling a new system is huge for any healthcare system, and we also had 5010 that occurred.

"We're in a unique area in Southeast Florida," Wood adds, "where we're impacted heavily by our tourists - our seasonal population doubles during the winter months. So we're dealing with a new patient accounting system, the transition to 5010, and then we have our seasonal influx of patients who are 60-percent Medicare, 10-percent Medicaid; so as you can see, we're heavily reliant on government there.

"We knew that getting the whole ICD-10 system ready was going to be a very difficult challenge for us. Now that we have this extra year, and our patient accounting system has settled down, we'll be turning our focus to ICD-10 education."

Naples coding staff has been working through Precyse University for nearly a year on the education component. "They've done all the modules, and now are going back through them again," Wood explains. "We're doing monthly workshops with staff based on those modules so we can be sure they're going to be ready for everything."Naples has also engaged Cerner, which manages the health system's IT services, to assess where ICD-9 codes reside in its Cerner Millenium system.

"They're coming to meet with us later this month with the results, which will let us know where in the system we'll potentially need to translate ICD-9 codes to ICD-10," she says. That baseline assessment will enable Wood and her team to put together an ICD-10 task force and work plan.

"We have a huge task ahead of us," she adds, "but we've got a lot of the building blocks in place."