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Y2K vs. ICD-10: 13 years and 124,000 codes Many have touted the ICD-9 to ICD-10 conversion as similar to Y2K. Considerable preparation, testing, working with vendors and go-live anxiety was the order of the day for Y2K. Yet, it was much ado about nothing. The transition to ICD-10 will be a much different experience. Y2K involved primarily systems technology, while ICD-10 goes beyond technology to involve workfl ow changes, policy and procedure changes, screen and report format changes, data conversion, education, training and more. Specifi c areas of concern include: • 16,000 codes converted to 154,000 codes and vice-versa.

• It’s a nationwide, single-day, big-bang approach.

• Most of the change will occur in health- information management (HIM) and information technology (IT).

• Physician documentation must be more specifi c and granular.

• Wide breadth of systems will be im- pacted, primary and downstream.

• All system interfaces must be tested and potentially updated.

• Mapping and crosswalks will be used as a short-term bridge.

the road. Under ICD-10, inaccurate and incomplete physician documentation will not suffi ce, and coders will be forced to relentlessly query physicians for ad- ditional information. From a systems perspective, there are three major problems associated with the conversion from ICD- 9 to ICD-10. Number one is the breadth of systems requiring upgrade or replacement. Number two is the issue of interfaces. Number three is the issue of mapping I-9 to I-10 and I-10 to I-9 and building a crosswalk between them.

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Katie Carolan is vice president of operations, Health Record

Kti C l i i

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On Oct. 1, 2013, nearly 16,000 1CD-9 codes must convert to more than 154,000 ICD-10 codes (or vice- versa) in a multitude of systems. Furthermore, ICD-9 coded diagnosis and procedure information must be converted to ICD-10 for any type of clinical decision support, reporting or longitudinal studies. For HIM departments, the transition will be a huge change. CIOs must work very closely with HIM and align their teams accordingly. The integration of ICD- 10 codes into the revenue cycle is another important area for careful analysis. Failure to successfully convert will result in failed claims and halted cash fl ow. All Medicare billing for discharges on or after Oct. 1, 2013 will be ICD-10 based. Sept. 30, 2013 discharges are ICD-9 based. Think about the billing, revenue-claims adjudication and accounts-receivable issues involved with a single- day, big-bang go-live event – and one easily understands the enormity of the task at hand. Last, and certainly not least, ICD-10 will require the involvement of physicians. Physician documen- tation must become more specifi c and granular to accommodate ICD-10 coding. Failure to train physi- cians on documentation and terminology specifi city requirements now will result in great frustration down

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CIOs must assess all technology now Essentially, every system in the institu- tion needs to be part of the ICD-10 assess- ment and should be evaluated now. There is evidence to suggest that many organizations have systems in place that CIOs are not responsible for, and in fact may not know about. These, primarily clinical, systems often capture, share and/or store codes; and, further, they send this information to billing and EHR systems. The assessment and potential replacement or upgrade of these downstream systems is an enormous undertaking and is in addition to the work needed on the institutions’ primary applica- tions (see Table). Finally, interfaces between and among systems must also be updated to accom- modate ICD-10.

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Many vendors are sitting back, waiting for hospitals to come to them and tell them what is needed. Do not assume your vendors will be ready and that your current version of software will comply. Organizations should be assertive, if not aggressive, in pursuing ven- dors’ ICD-10 plans. Questions to ask include: • Which version of the software will be ICD-10 ready?

• What is the timeline for general availability of this version?

• What will be the cost to upgrade current systems, if any?

• What are the ongoing costs (upgrades and support) for the new version?

If upgrade or new support costs are substantial enough, 2011 may be an ideal time to consider changing systems. Benefi ts of new applications include software designed with ICD-10 in mind and ongoing support for the ICD-10 version. Furthermore, vendors should pro- vide working systems well ahead of the 2013 deadline. Having a full test environment available with vendor support on hand is best practice. Finally, organizations will need dual processing capabilities for quite some

HEALTH MANAGEMENT TECHNOLOGY February 2011 9

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