Global Lessons: Planning and Preparation are Keys to ICD-10 Success

The Americal Recovery and Reinvestment Act (ARRA) provides incentives to modernize health care, including the upgrade to a new medical coding standard, ICD-10.

The Gartner Group, a leading research organization has called the transition to ICD-10 “a momentous change.” However, it also states that, “In the long run, ICD-10 is a key enabler for quality improvement, better management planning and better care.” Better care, isn’t that what every provider organization is trying to achieve?

For more than a decade, AHIMA has warned of the problems that exist with the ICD-9-CM system, while artfully promoting the value proposition of ICD-10. The AHIMA site offers a wealth of information from which CIOs and other senior executives can benefit.

We need first to understand some of the baseline deficiencies inherent as we continue to use the ICD-9-CM system. ICD-9-CM is obsolescent. The system is quickly running out of space for new codes, thereby limiting the inclusion of new procedures and diagnoses. Further, it is not sufficiently precise to fully enable an EHR, conform to pay-for-performance reporting requirements, adversely affects DRGs by grouping different procedures into a single code, and decreases our already considerable investment in SNOMED-CT.

Whether you work for a provider or payer, keep this in mind as we move to the October 1, 2013 compliance date.

HIPAA X12 5010, the EDI standard required for implementing ICD-10 has an earlier date than 2013.
Implementation of the EDI standard needs to be well in hand for your organization by 2011. That isn't far away if you are a large enterprise organization.
Process impacts are easy to miss if IT and busines aren't partnered.
Planning and preparation are keys to success
Education is a must
Network and reach out to others to learn from their experiences

We can learn from ICD-10 implementations that have already taken place in other countries. Thailand *yes Thailand* implemented ICD-10 in 1994. The U.S. is implementing a version of ICD-10 which the W.H.O. granted permission for it to modify, ICD-10-CM

Here is a summary of lessons learned from the Canadian experience with ICD-10 implementations.

According to a post from AAPC:

"The International Classification of Disease (ICD) is used for classifying diseases and other health problems recorded on many types of vital records including death certificates and hospital records. The International Statistical Classification of Diseases and Related Health Problems, 10^th Revision (ICD-10-WHO) is maintained by the World Health Organization and was endorsed by the 43^rd World Health Assembly in May 1990. Many countries around the world began implementing ICD-10 for mortality statistics in 1994. In the natural progression of coding medical records, various countries around the world began to contemplate the idea of using ICD-10 for morbidity data.

Since the World Health Organization (WHO) holds the copyright to ICD-10, those countries seeking to modify the system had to request permission to do so. All modifications must be approved by WHO to keep certain standards and conventions in place. By imposing standards and restrictions the coding integrity is maintained allowing for comparative analysis between counties on global conditions and diseases.

Countries that have sought and gained approval to create their own ICD-10 include Australia (ICD-10-AM), Thailand (ICD-10-TM), Germany (ICD-10-GM), Canada (ICD-10-CA) and the United States (ICD-10-CM).

Of particular interest to the United States is the experience Canada had in the implementation of ICD-10. Our neighboring country, Canada sought approval to modify ICD 10 from WHO in 1995, began work to modify the codes in 1999 and commenced adoption in April 2001.

The rollout of the new code set in Canada was different in some respects from the anticipated rollout in the United States. Canada’s universal, single-payer system is funded and regulated at the federal level but coordinated at the provincial level. In the Canadian ICD-10 rollout, each province had the ability to determine the date for their specific implementation. As a result, provincial implementation of ICD-10-CA was staggered beginning in 2001 with completion by April 2005. We do not have a single-payer system nor do our states have the same control as the Canadian provinces; as such, our implementation effort will not be staggered.

A somewhat interesting challenge that Canada had was that when they rolled out the ICD 10 system, Windows-based computer software was just making the scene. Not only were Canadian coders faced with a new code set, but they were also faced with the challenge of changing from using hardbound books to desktop Windows-based applications for their reference materials.

What they did implement that we should take note of as we embark on this journey is focused attention to planning and early commitment from industry stake holders including government leaders and agencies, professional associations, colleges and universities, providers and vendors.

The Canadian experience suggests three key points to remember: