AUGUSTA, Maine — Health care providers across the state began working Oct. 1 with a new system of medical codes that has them describing illnesses and injuries in more detail than ever before, and officials from hospitals and medical associations said earlier this week that they are prepared for the challenge.
At the beginning of this month, more than 100,000 new medical codes took effect in hospitals across the nation as part of the 10th revision of the International Classification of Diseases, or ICD-10. The revisions were made to keep up with changes in medical technology and patient treatment.
Gordon H. Smith is the executive vice president of the Maine Medical Association, the largest physician organization in the state that works to support physicians, advance the quality of medicine in Maine and promote the health of all of its citizens.
“It is going to be a big change for everyone because there are way more codes now,” Smith said. “But this is something that has been planned for way in advance and I think the worst is behind us and we are ready.”
Every time a health care provider treats a patient and makes out a bill for payment, a code is assigned to the claim. With this new system, the codes are much more detailed. Providers must specify in which part of the limb a break or fracture occurred, and explain if a patient with a primary disease, like multiple sclerosis, also has a secondary illness, like kidney disease.
There are codes for the more common illnesses, such as Vitamin D deficiency, (Code E55.9), or Type 1 diabetes, without complication (Code E10.9,) or the incredible, such as if you are crushed by a crocodile, which is (Code W58.13.)
Smith explained that many health care providers have been planning for two years for the implementation of ICD-10 and have largely put aside fears that claims will be denied or that payments to insurance companies will be delayed if certain new codes are not used or not used properly. He said that health care providers got ahead of the problem by training coders and also finding software and vendors that would do the billing for them.
“I have heard no complaints about this or about any delays,” he said earlier this week.
Kate McKissick is the health information management supervisor for Houlton Regional Hospital. She said Friday that as part of their ICD-10 transition process, they hired Julie DeMaere, revenue cycle analyst, to train all of the coders in ICD-10 and also hired another coder to assist with what McKissick said would be an “inevitable backlog” as coders and providers learn the new system.
“Some of our people have worked for us for 30 years, so we anticipate that it will take them time to learn this new system,” she said.
Both McKissick and DeMaere said that a benefit of ICD-10 is that it will help insurance companies, health care organizations and other health data collection agencies collect and provide more specific information about how patients are suffering injuries, illnesses, contracting diseases and more.
With a code number for crushed by a crocodile, for example, The World Health Organization may be able to better provide more data on the number of people worldwide who suffered such an injury.
ICD-10 includes 68,000 diagnostic codes, compared with 14,000 in the current collection. The new catalog of codes includes more than 100 for gout and more than 200 for diabetes. There are more than 30 codes for injuries caused by acts of terrorism, according to a New York Times article on the subject.
Eastern Maine Medical Center in Bangor also began preparing months ago for the change by adding extra coders, according to Mandy Reid, director of coding and clinical documentation improvement.
“Our transition to ICD-10 has gone very smoothly here at Eastern Maine Medical Center,” she said “We are using nine contract coders through outside vendors to support the ICD-10 go-live, and we secured them several months ago to be prepared. We also have added three positions in the outpatient area to help support growing volume, as well as ICD-10 coding.”
At the Maine Hospital Association, Becky Schnur, director of communications, said that for hospitals across the state a lot of training went into making sure the transition to ICD-10 went smoothly.
“Thus far from our membership, there have been no complaints,” she said.
Schnur said that most of the attention on this changeover has been because some of the new codes have been so detailed.
“They have added a lot of codes, but most of them are ones coder’s working in surgeon’s or pediatrician’s offices will never use,” he said. “That coder may use maybe 30 of the new codes.”
“Here in our hospital, I think it is the coders in orthopedics who will have to learn the most new codes,” she said. “Simply because they have to be the most specific. If, for instance, a fracture or a crush injury occurs in the hand, they have to use the coding system to indicate if there might have been fingers broken or crushed, and were they on the left or the right hand, and were the injuries in the top or the bottom of the fingers. That is where I think it will be challenging.”
Emily Brostek, executive director for Consumers for Affordable Healthcare Maine, a Maine advocacy organization, said people should be more vigilant in checking their medical bills for errors in the coming months.
“People should be especially vigilant, because coding errors can cause problems for patients,” she said. “We are expecting that this is something that we might get some calls on. Mistakes can happen, so it is always important to double check,” said Brostek, whose organization works to ensure a strong consumer voice in all health care decisions.