How many new codes? Welcome to ICD-10

Doug Koekkoek, M.D.
Chief executive, clinical services
Chief medical officer

Sept. 18, 2013

If you liked high school French class, you should love ICD-10. Yes, the conversion to the International Classification of Diseases, 10th revision, is something like learning a new language. Fortunately we will have translators standing by.

On Oct. 1, 2014, every hospital, pharmacy and physician in the country will be required to submit new ICD-10 diagnoses and procedure codes for their charges to the Centers for Medicare & Medicaid Services and to commercial insurers.

Both hospitals and physicians have skin in this game, so we need to work together to learn the new system.
Unlike ICD-9's three- to five-digit numeric codes, ICD-10 uses up to seven alpha and numeric characters. Overnight, 13,000 diagnosis codes will grow to more than 68,000. The current 3,000 procedure codes will be replaced by up to 87,000 new codes. Nine pressure ulcer codes expand to more than 150. Angioplasty will go from one code to 854.

The coding manuals include a vast array of new terms – “extraction” rather than “delivery,” “drainage” instead of “aspiration,” and so on. Thankfully, physicians will not be required to memorize all these terms, but we will need to be aware of a number of specialty-specific requirements for accurate coding (and billing). These include laterality, initial vs. subsequent, open vs. percutaneous, and in general much greater anatomic specificity.

Providence is working to ensure that our information systems and our multiple software programs are updated and ready to interface with the ICD-10 codes, and we’re preparing for billing compliance.

J.A. Thomas & Associates will hold ICD-10 general education sessions this fall at six Oregon hospitals. You'll receive notice of specific locations and times.

Providence Portland: Tuesday, Nov. 12
Providence Milwaukie: Wednesday, Nov. 13
Providence Willamette Falls: Thursday, Nov. 14
Providence St. Vincent: Tuesday, Dec. 10
Providence Newberg: Wednesday, Dec. 11
Providence Medford: Thursday, Dec. 12

See our Oregon ICD-10 Education page for details about these events.

Online modules for general and specialty-specific ICD-10 education will be in place before the fall of 2014.

Epic will be populated with ICD-10-compliant diagnoses, so physicians who document using the Problem List in Epic will have their way eased. Providence also will add staff to our clinical documentation improvement programs so that our concurrent review nurses can help physicians with correct documentation in real time. The current plan is to begin dual coding in both ICD-9 and ICD-10 for a few months before the go-live date in October 2014.

The Brits transitioned to ICD in 1995. France followed in 1997, and our Canadian neighbors moved to ICD-10 in 2001, so we can do this too. While the new standard was not Providence’s decision, we’ll be there to help with as much education and support as possible. To learn more, visit CMS's ICD-10 website.