April 18, 2011

Billy's World: What in the World IS Going On?

By

Would you believe that Congress passed a law requiring the adoption of the metric system of measurement in 1975?

Would you believe it was earlier? Later?

Actually, Congress never has mandated the use of the metric system (or the commonly used modern version, the International System of Units). However…

  • In 1875, the U. S. was an original signatory at the Metre Convention (the “Treaty of the Meter”), which established the metric system as the international standard of measurement; and
  • In 1893, the Mendenhall Order established metric standards as the fundamental standards of length and mass in the U.S. (for 118 years, the “foot” has been defined in metric units, rather than as the length of a grown man’s foot.

And yet, the United States today is one of only three countries in the world that still use “customary” units, otherwise known as “English measure:” pounds, ounces, feet, yards, miles, Fahrenheit, etc. We share that distinction with…wait for it

Burma and Liberia. Go figure.

So, what’s the point, you ask? Well, apparently following this precedent, we are moving at about 62 percent of a snail’s pace to implement ICD-10. But before we go there, let’s get some background by taking a look at the components of ICD-10.

ICD-10: The International Classification of Diseases, Version 10, is copyrighted by the World Health Organization, as has been true of every version of ICD since 1947. ICD-10 was endorsed by the 43rd World Health Assembly in 1990 (21 years ago!) and primarily is used for “death coding.” In fact, its use has been required for reporting mortality statistics in the U. S. since 1999. Of course, being required and actually being used aren’t the same thing, which helps explain why it has been used for reporting mortality statistics in the United States only since 2007.

ICD-10-CM: The “clinical modification” of the WHO listing is copyrighted by the CDC and others, and it expands the list to include all diagnoses, both for the living and the deceased. This is the system that will be used to code medical records and claims, of course, utilized by hospitals and professional practitioners alike.

ICD-10-PCS: The “procedural coding system” was developed by CMS (the Centers for Medicare & Medicaid Services…and why does “CMS” have only one “m,” incidentally?) because ICD-10 doesn’t include any procedural coding. You see, our not-particularly-forward-thinking benefactors-in-government imposed the HIPAA Transaction Rule on providers, payers, clearing houses, and – most recently – business associates. And it says you cannot use CPT codes on an inpatient claim.

So, we need ICD-10 procedure codes in order to bill inpatient claims that are compliant with the transaction rule. You see how nicely this all fits together?  Ok…maybe not…

All of which brings us to “Problema Numero Uno:”

How do we convert (“crosswalk”) the present ICD-9 codes to ICD-10, and vice-versa?

The answer: We don’t. Not really, anyway.  

Oh, surely CMS came up with “GEM”(the “General Equivalency Mapping”) to handle those crosswalks, but guess what? ICD-9 to ICD-10 essentially is a “one-to-many” relationship, and there are very few clean “9-to-10” crosswalks. So, what to do?

Well, when all else fails you fall back on probability, and execute the crosswalk based on the “most common” mapping. Good luck getting anything to match until everyone uses the same system!

Last, but certainly not least, to finish:

Did you know that ICD-11 is being programmed for adoption by WHO in 2015?  

It’s only going to get worse.

Until next time…

BKR

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

Contact the Author

Read 4 times Updated on September 23, 2013
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.