Columbia University Medical Center

Simplifying ICD-10: It Takes a Village

ICD-10 conversion sounds like the domain of information technology and compliance officers–and in many ways it is. But moving from ICD-9 to ICD-10 has required dedicated clinical support from physician leadership to provide clear insight into the nuances of coding for each department and division.

Tim Crimmins

Timothy J. Crimmins, MD

“Converting the electronic record from ICD-9 to -10 and fixing the back-end logic of CROWN so it sends out orders and bills correctly is a large but fairly straightforward project,” saysTimothy J Crimmins, MD, RPVI, director of clinical integration for ColumbiaDoctors.

“However, linking this to how providers actually do their work is the big challenge. We need to connect these changes with how the physician selects a diagnosis for the patient, how he or she documents that diagnosis within the note, and how that’s put into each patient’s chart. By getting this right, we will make sure quality patient care continues and there aren’t any problems with reimbursement.”

That’s why champions from each department have taken a leading role in moving the process forward in recent months. The idea, says Dr. Crimmins, is to tap into the knowledge base of practitioners who know the practices and workflows of their respective specialties.
“They can take the transition from 9 to 10 past the technical into the clinical realm by making decisions on behalf of their colleagues about how diagnoses are set up in CROWN, deciding what is displayed in the CROWN ‘favorites’ list, and then educating their colleagues about these changes.”

Comana Cioroiu, MD

Comana Cioroiu, MD

One of those 20 champions is Comana Cioroiu, MD, assistant professor of neurology, whose department includes about 100 physicians and 17 subspecialties. She has been charged with identifying a new list of CROWN favorite codes. “She really took charge for her department and all its subspecialties,” says Dr. Crimmins. “She has been very involved in the details of each one of them.”

“With the increased specificity of ICD-10, there will be many more codes and often more than one code for many diagnoses. When everyone’s making the transition from ICD-9 to ICD-10, you don’t want to them to be overwhelmed by thousands of codes,” Dr. Ciorioiu says. “All of our subspecialties have their own scope in CROWN, with many different, unique workflows and clinical arrangements.”

So Dr. Cioroiu, like her fellow champions, took on the unenviable task of paring down these thousands of codes to about 70 favorites per division. “We tried to keep the list down to between 25 to 30 ICD-9 codes, but each one of those codes might expand to 10 ICD-10 codes, and we had to choose which of those were most important.”

After identifying those codes, Dr. Cioroiu’s next step was to contact representatives of each division within the Department of Neurology to discuss division-specific issues related to the transition. “For example, some divisions have procedure codes and some don’t — neuromuscular has EMG, epilepsy has EEG. In ICD-10, the codes will have to be much more specific in order for those procedures to be reimbursable. We need to make sure that everyone in the department is fully trained and understands what’s coming.”

Paring down the exhaustive list of ICD-10 diagnoses into a manageable list of CROWN favorites has been the most challenging task so far, especially for the larger departments like neurology and pediatrics, says Dr. Cioroiu. “But I think our biggest challenge is likely ahead of us, once we start introducing ICD-10 to all of the physicians, and the questions and concerns that will come with that. Fortunately, all the departments seem to recognize that we are in this together and facing the same challenges.”

Preparation for the transition is very different from live implementation, she says. “This will be an ongoing learning process, and no one can predict exactly how this will play out or what all the exact implications of the transition will be,” she says. But Cioroiu predicts that the transition will be smoother than some are anticipating. “We hope to have things working very smoothly within the first year.”