July 21, 2014

ICD-10 Ready to Roll Out October 2014 at University of Mississippi

By

EDITOR’S NOTE: John Showalter, MD, chief medical information officer for the University of Mississippi Medical Center, told Talk Ten Tuesdays audience members last week that his facility will be prepared to roll out ICD-10 by October 2014. Talk-Ten-Tuesday followed up with Dr. Showalter.

 

TTT:

When did the University of Mississippi Medical Center begin its implementation of ICD-10?

UMMC:

We started our ICD-10 project in July of 2013.

TTT:

How many physicians are currently using ICD-10?

UMMC:

More than 1,200 physicians, residents, nurse practitioners, and physician assistants at our main campus are currently using ICD-10. I doubt many of our providers would be able to tell you that it happened. Since our EHR uses SNOMED terminology for the problem list and encounter diagnoses, we were able to include the more complete ICD-10 level of specificity without changing their workflows. All the providers noted was that a search returned a longer list of diagnoses to choose from. We map the terms to ICD-9 codes today and will switch to ICD-10 on the compliance date. This method should mean very little change to provider workflows and a seamless transition to ICD-10.

TTT:

What is the status of your end-to-end testing with Medicaid?

UMMC:

We have completed end-to-end testing with Mississippi Medicaid for both facility and professional claims. Over the course of three weeks, we sent more than 250 claims to Medicaid. The test claim files were based on real patient encounters that were recoded to ICD-10 diagnosis codes. The encounters were selected to reflect our most frequent claim submissions.

TTT:

What are some of the issues that this testing has uncovered?

UMMC:

Overall, the testing was successful and gave us a good confidence boost regarding our ICD-10 coding capabilities and our system performance. An early find in the process was that certain steps in the data exchange were unprepared for the alphanumeric structure of the ICD-10 code set. All interfaces were updated to allow the exchange of alphanumeric data. The rest of testing went smoothly, with acceptance and rejection codes transferring appropriately between systems.

TTT:

When do you expect to begin Medicare testing?

UMMC:

We successfully participated in the March 2014 acceptance testing with Medicare and are prepared to participate in further Medicare testing as soon as it is announced.

TTT:

How have physicians reacted to CDI education?

UMMC:

The collaboration around clinical documentation improvement between CDI specialists, ICD-10-trained coders, and clinicians has been enthusiastic and productive. Since we started our ICD-10 CDI initiative six months ago, we have seen a consistent year-over-year rise in case mix index (CMI) and our physicians are pleased with the increased amount of documentation support they are receiving. Focusing on a service line-based program of Clinical Documentation Excellence, we are selecting initiatives that will provide the most impact for each area based on its needs.

TTT:

When will you have completely implemented ICD-10? 

UMMC:

From a clinical perspective, the implementation will be completed October 1, 2014. At that point, we will be requiring ICD-10 levels of specificity for clinical and billing diagnosis, just as we had planned prior to the delay. We believe the use of specific diagnosis is in the best interest of our patients and will be moving ahead even without the government mandate.

With regards to claims submission, we will continue payer testing and optimizing our system to submit ICD-10 codes on claims to meet the October 1, 2015 deadline. However, our focus is not on any particular date for claims submission. The focus is on what we can control and what we can do to help improve the care for our patients.

TTT:

Why has there been (or so it appears) so little attention paid to patient care benefits of I-10?

UMMC:

Preparing every physician office, every hospital, and every payer to send and receive a new code set is a massive undertaking. Every stakeholder learning a new code set is a separate and perhaps even more massive undertaking.

The energy that these efforts consume leaves little energy to discuss why it is important to make the transition. Also, the messaging focuses on the US being late to adopt ICD-10. Furthermore, the value of the transition to patients isn’t clear until you take the time to learn about the new codes and consider how the codes will be used in the future.

The ICD-10 terminology is baked into the SNOMED ontology that is the interoperability standard for Meaningful Use and Health Information Exchanges due to its mandated use in CCD-A documents. Perhaps one of the most straightforward examples is breast cancer.

If you are only using ICD-9 terminology, you can specify an area of the breast where the tumor was found, but you can’t identify which breast. With ICD-10, you can add the laterality. If the patient is transferring care and a consolidated-clinical documentation architecture (C-CDA) is sent to the next provider, it is clearly in the patient’s best interest that the C-CDA includes in which breast the patient had a malignant tumor.

ICD-10 will not be used for just billing. It will be used for patient care, research, and population management. ICD-9 simply doesn’t have the details to be used for all those purposes.

 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.