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Published in CenterView on July 15, 2013

Well-seasoned DIS staff ready to prepare clinicians for looming ICD-10 conversion

By Bruce Coleman

Physicians, nurses and other clinical staff at the University of Mississippi Medical Center are about to learn a new “language.”


They couldn’t be at a better place to master it.

The federal government is moving forward with its mandate that the U.S. health-care industry adopt the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), a medical classification list authored by the World Health Organization, by October 2014. The United States has used the previous version of the system, ICD-9, since 1979; most countries migrated to ICD-10 more than a decade ago.

Part of the Administrative Simplification Provision of the Patient Protection and Affordable Care Act, the cost of converting from ICD-9 to ICD-10 is tremendous – conservatively estimated by the U.S. Department of Health and Human Services to be more than $1.6 billion nationwide – but the coding upgrade is anticipated to improve clinical communication, public health reporting, research and quality, according to Leigh Williams, director of health information management.


“The new code set allows for advances in technology and for more specific gathering of information, which allows researchers to better understand what is happening to the health of various populations,” Williams said. “It helps us more accurately and completely understand what is going on with patients.”

That understanding is particularly critical in rural states such as Mississippi, which consistently trails other areas of the country in categories such as heart disease, stroke and diabetes.

“Understanding the population of Mississippi is key to improving the health of the state,” said Dr. John Showalter, assistant professor of medicine and chief health information officer. “The increased specificity and granularity of ICD-10 will create data during the documentation and billing of medical care that can more completely describe populations.


“Researchers will have the ability to more accurately identify groups that would benefit from novel investigations, and staff will benefit from a more standard communication as documentation improves. In many cases, we will be able to understand complete populations, where previously we were only able to sample records and make estimates.”

ICD-10 could be thought of as a Dewey Decimal System for the classification of diseases. It refers to two distinct code sets for billing and epidemiological functions, respectively: a clinical modification system that contains all of the diagnoses for disease processes – called ICD-10-CM – and a procedural coding system that documents the treatment of clinical manifestations of those diseases – called ICD-10-PCS.

Developed by the Center for Disease Control’s National Center for Health Statistics, ICD-10-CM codes, made up of three-to-seven alphanumeric characters, allow for more accurate reporting of diseases. On the other hand, the seven-character ICD-10-PCS codes have a different purpose: they contain unique, precise alphanumeric codes to differentiate such categories as body parts, health-care approaches and devices used in any medical procedure one could imagine.

“The new code allows you, over time, to add things to the code set so you can stay current with advances in technology and advances in health care,” Williams said. “Placeholder characters (in the ICD-10-PCS coding system) allow for future innovations in health care, to chart growth in technology.”

If the explanation of how ICD-10 codes work seems a bit technical, imagine learning how to put them into practice. For many clinical staff, ICD-10 may seem reminiscent of the Y2K conversion efforts of the late 1990s or the more recent implementation of EPIC, the Medical Center’s electronic health records system.

Fortunately, the Division of Information Systems is well prepared to help all Medical Center clinical personnel become proficient in ICD-10 coding before the October 2014 deadline.

“Our organization is well positioned for this because we just went through a major (EPIC) conversion,” Williams said. “We heard from our people what worked well, and we have that experience to draw from as we prepare ICD-10 training.”

“We want to start educating our physicians, nurses and clinical staff so that they are aware of what’s happening with ICD-10 and why it’s happening,” said Julie Green, IT program manager. “As we get closer to the official ICD-10 implementation date, we will offer specific training based on lessons learned.

“We don’t want to surprise anybody.”


During the next 15 months, DIS plans to offer ICD-10 training for clinical staff on four main fronts

   •  Starting in July, monthly lunch-and-learn seminars will invite open discussions on a number of ICD-10 conversion topics.

   •  Free lunchtime webinars will offer online training for coders and CDI specialists from the convenience of their desktops, laptops or mobile devices.

   •  ICD-10 education programs will be available to physicians, coders and others online through HealthStream, easily accessible on the UMMC Intranet.

   •  Training sessions by ICD-10 experts will target specific groups for specialized instruction.


“In any given month, there will be 10-to-15 educational opportunities for our employees to tap into,” said Williams. “As an academic medical center, we know how to roll out major initiatives. We do education here very well.

“We’re going to prepare our staff for the ICD-10 conversion in the best possible way.”

The biggest challenge of the conversion, according to Showalter, is maintaining accurate communication through the meticulous and proper documentation of diseases, signs, symptoms and treatments.

“Providers will be challenged to learn the details and words that are necessary to include in their documentation,” he said. “ICD-10 is completely driven by what the provider writes. They will need to spend significant time learning the new nomenclature.”

Williams agrees. “Getting physicians to describe in enough detail all of the information needed in order to apply the appropriate code is critical,” she said. “The complexity is greater in ICD-10, so getting physicians to understand what’s needed for their specialties and getting them to complete that information during their patient encounters is the deal-breaker here.

“And not just physicians, but clinicians and nursing staff need to be diligent and aware of what is needed.”

But the tradeoff - especially to those who the Medical Center serves – is well worth the investment, according to Williams.

“The fact we will be able to better empower researchers to do better population studies is one major advantage,” she said. “They will be able to mine good data about various health issues in the U.S. in very tangible, real ways that will help us understand how various treatments work for certain populations.

“What’s really going to be powerful is that, in 10 to 15 years, there may be trends that emerge from this data that could be compared globally, not just in the U.S. We’ve been out of synch with the rest of the world – with ICD-10 implementation, we’ll be able to compare our data with the rest of the world.”

To view a schedule of all upcoming ICD-10 training opportunities, visit (

(Click to enlarge code chart)