The new system called ICD-10 is the tenth revision of the International Classification of Diseases used to classify medical conditions and procedures. The implementation is the first nationwide update in 35 years, according to the U.S. Department of Health and Human Services, the principal Federal agency responsible for protecting the health of all Americans.
"The ICD-10 codes are designed to provide better support for patient care, and improve disease management, quality measurement, compliance and reimbursement," said Denise Schultz, Regional Coding Consultant and Regional ICD-10 Project Lead.
According to Schultz, it took a team approach to ensure that the region ramp up their operations to ensure the technology systems and business processes would be ready to make the switch on time and with confidence. "There was no benchmark. It's all new so we had a very aggressive timeline to ensure we were ready to meet the mandatory implementation date," Schultz said.
Each of the region's medical centers, hospitals and clinics were responsible for creating an action plan to best train their staff and support the medical providers who care for the region's beneficiaries. At Kenner Army Health Clinic, Fort Lee, Virginia, medical coders were embedded in clinics for six months to a year to develop relationships with the clinical teams to better understand how to assist them in meeting the new ICD-10 coding requirements.
"This was a very important part of our approach to getting ready for the transition," said Capt. Ronald Weaver, chief, Kenner Patient Administration Division. "Getting down to the clinic level and really seeing how they work and become a part of those clinics we hope will make it easier in the first few critical days when we will most likely see any 'speed bumps' or deficiencies in the training or understanding the new system."
ICD-10 training at the Fort Drum Medical Activity (MEDDAC), Fort Drum, New York, incorporated American Academy of Professional Coders training and passing a proficiency test.
"Testing and working with our IT [information technology] team on building templates was an important part of our transition process," said Karen Astafan, medical records technician and coding supervisor, Fort Drum MEDDAC.
The region also established an ICD-10 Risk Mitigation Team with experts across a range of disciplines--logistics, informatics, patient administration, resource management, legal, operations, clinical operations--to support the region's medical treatment facilities during their training, in the first critical weeks after implementation and beyond.
A medical coder with more than 20 years' experience, Corcedia Thurman, Kenner Army Health Clinic, said that ICD-10 represents a learning curve and a greater time investment for the providers. "There are 68,000 codes now versus the 13,000 we were using. So, we had a lot of work to do to explain why those additional codes are important and why the new codes support better care coordination, especially for patients with complex illness and multiple providers."
With ICD-10, doctors can capture much more information, meaning they can better understand important details about the patient's health than with the ICD-9. For example, when a patient visits the doctor with a broken leg, the new codes will allow doctors to indicate which leg and the specific location.
The greater level of detail also allows doctors, researchers and public health officials to better track chronic diseases and health outcomes, which according to Schultz should support quality of care and the focus on prevention services needed to transform Army medicine from a health system to a System for Health.
"ICD-9 was in use for a long time so it was very familiar to our staff and providers," said Astafan. "It will take a while but once we start using the new codes, I think we will be fine."
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