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New medical coding system aims to help track quality of care

Mayo Clinic has its hands full adapting to a massive new coding system that goes in effect on Thursday.

All the nation's physicians and hospitals must start using the new coding system to describe patient visits on insurance claims.

U.S. health providers now use a system of about 14,000 codes to designate a diagnosis, for reimbursement purposes and in medical databases. To get more precise, the updated system has about 68,000 codes, essentially an expanded dictionary to capture more of the details from a patient's chart.

How precise? Get nipped feeding a bird, and the codes can distinguish if it was a goose or a parrot. Have a bike accident with one of those horse-drawn tourist carriages? Yep, there's a code for that, too.

According to a Mayo Clinic statement about the conversion, the coding expansion affects not only clinicians "but staff in a range of departments, from finance and IT to research analytics." The Clinic provided no hard numbers but said "thousands of employees have been involved in either successfully converting Mayo Clinic to ICD-10 or in learning how to use ICD-10."


"The scope of the project is vast," according to the statement, "requiring modification of more than 200 interrelated Mayo Clinic systems" including clinical, revenue and research.

The project involves Mayo Clinic sites in six states using four electronic health records and multiple revenue cycle systems as well as hundreds of payers and several thousand providers.

To guide its transition to the new codes, Olmsted Medical Center created a strategic steering committee in 2011.

"Over the past four years, this committee and its three workgroups have guided OMC's efforts to begin using ICD-10 codes for hospital inpatient diagnoses, procedures, and treatments beginning Thursday, Oct. 1, 2015," according to a statement from spokesman Jeremy Salucka. "As a result, OMC's care teams are very well prepared to switch over to the ICD-10 coding system on that date. We anticipate no delays or unexpected difficulties related to the transition and patients/visitors should not notice any related disruption in the care we provide."

The government says the long-awaited change should help health officials better track quality of care, spot early warning signs of a brewing outbreak or look for illness or injury trends.

Under ICD-10 — the 10th edition of the International Classification of Diseases — there are codes that flag novel strains of flu, for example, and even Ebola and its cousins. With increasing focus on sports concussions, the codes can reflect how long patients lost consciousness and if they needed repeat care.

"ICD-10 has the potential to create many improvements in our public health system," Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, told health providers in a recent conference call.

But with the deadline approaching, he urged providers to make sure their offices are ready, and that they take advantage of Medicare-offered testing that lets whoever handles their billing file practice claims.


Might patients see an uptick in insurance denials for coding errors that require the doctor's office to refile the claims? Dr. Robert Wergin, president of the American Academy of Family Physicians, is optimistic that providers are ready enough that patients shouldn't feel an impact.

"Sitting in the room with a patient, I don't think you'll notice anything," Wergin said.

His 10-doctor practice in rural Milford, Neb., has updated the electronic medical records of patients with chronic diseases, so the next time the diabetic with early kidney disease comes in, that new code is one less thing to check.

Most doctors' offices only use several dozen codes anyway, to match each specialty's typical diagnoses, Wergin noted. "Really, I probably live in a world of 140 codes."

Why are codes so important? It goes beyond documenting that the bill is accurate — no reimbursement for a wrist X-ray if the diagnosis was knee pain.

With medical care gone digital, more precise diagnosis codes could allow researchers, even doctors, to get a closer look at trends in one office or the entire country, Wergin said. A search of an office's data could show how, say, all pregnant women with a urinary tract infection in the third trimester fared.

The new codes, already used in many other countries, indicate if it's a first visit or a repeat. A spike in repeat visits for strep throat might indicate a more worrisome strain is spreading. This kind of data also is used by insurers and other organizations to help determine quality of care.

According to Mayo Clinic, "converting to ICD-10 offers many more advantages than simply complying with a federal mandate."


"Because it calls for more precise coding and documentation, including signs, symptoms and risk factors of disease, it allows physicians to document the true complexity of patients' health needs," potentially leading to fewer rejected reimbursement claims.

"As such, converting to ICD-10 offers broad benefits that impact quality measurements, public health, research, organizational monitoring and performance as well as reimbursement."

Centers for Medicare and Medicaid Services can't estimate how many health providers are ready for the switch, but officials said they think most large practices and hospitals are, so the agency is intensifying its focus on smaller doctors' offices, said Dr. Mandy Cohen, CMS' chief of staff.

Private insurers told Congress months ago they were ready. They, too, are focusing on small providers.

"Health plans are working aggressively to help them get over the hump," said Justine Handelman of the Blue Cross Blue Shield Association, who noted the industry has had years to prepare. The U.S. postponed the deadline twice.

Still, responding to concerns from doctors, CMS has promised some flexibility in the first year of assessing claims, if the coding is close.

"There will be bumps and challenges," CMS' Slavitt said, as he appointed an ombudsman to be the contact for health providers who experience them.

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