How Big a Challenge is ICD-10? Ankle Sprain = 72 Codes

Donna Stewart, compliance manager at Children’s Hospital, Norfolk, Va., summarizes this transition to ICD-10 this way: “If successful, the data we’ll extract will be incredible for medicine.” To be sure, it’s a big “if,” yet Steward’s main point about the forthcoming diagnosis and procedure classification system is on point.
The new coding system, set for national implementation on Oct. 1, 2013, greatly expands the ability to describe patient conditions. Coding a simple ankle sprain, for example, will involve 72 codes, rather than the single code currently in play, Stewart told attendees at the World Congress Leadership Summit on ICD-10 in Vienna, Va. Because of the new granularity, which adds the “laterality” that is missing in ICD-9, coding staff, Stewart said, will need additional training in anatomy and physiology
In sum, ICD-10 expands the number of diagnosis codes from 14,000 to over 69,000, while the number of inpatient procedure codes grows from almost 4,000 to 72,000, Stewart explained. The conversion to the new coding system—which is the backbone of billing–will require even more specific documentation from physicians about work performed, she noted. In preparation for the transition, Children’s has identified the top 30 diagnoses rendered by its physicians, and has mapped them to the forthcoming code in ICD-10. At the same time, the hospital is conducting “readiness audits” of physicians to assure their documentation specificity will be up to par with requirements of the new codes.
–Gary Baldwin
SOURCE:  Health Data Management, HDM Daily 5/24/11