DeFord's estimate of total cost of ICD-10 conversion at Seattle Children's: $2 million in capital expenses and $8 million in operating expenses, spread across several years.
For a while, Seattle Children's will code in both ICD-9 and ICD-10. "There's a period of time certainly around the compliance date where patients will have been admitted before the compliance date and will be discharged after the compliance date," DeFord says. "The coding that will be in both ICD-9 and ICD-10 will really just be done to facilitate the claims around that time period."
Almost all doctors and clinicians at Seattle Children's are on the faculty of the University of Washington. "They will get the training for ICD-10," DeFord says. "They might be one of the most important pieces of the care team.
"For freestanding independent small-business men and women or small group practices who have hung out a shingle and they're doing their own thing, this is going to be a bit of a challenge," DeFord says.
"They are doctors first. They want to practice medicine. The business part of healthcare for them—especially as we go through a lot of these transitions, whether it's meaningful use or ICD-10—is a challenge," DeFord says.
Back in the land of AMA members, at least one physician practice organization is taking a different path to ICD-10 readiness.
Northwestern Memorial Physicians Group, a Chicago-based multisite practice of about 100 physicians who are on the medical staff at Northwestern Memorial Hospital and faculty members of Northwestern University's Feinberg School of Medicine, utilizes codes provided in software from Intelligent Medical Objects of Northbrook, Ill.
Today, those codes map to ICD-9, but when ICD-10 is ready, IMO codes will map to ICD-10 instead, says Lyle Berkowitz, MD, medical director of IT and innovation at NMPG.
"IMO codes are much more meaningful. I think they're even much better than SNOMED," Berkowitz says. "Are they perfect? Nothing is. But they'll be good enough from our perspective.
"Since IMO terms are more precise and user-friendly than ICD-9, it makes sense for us to use IMO now," Berkowitz says. "That way, we don't have to wait for ICD-10 to use better terms in our problem list, and the IMO terms can all be easily mapped to both ICD-9 and ICD-10 for billing purposes when needed."
For example, Berkowitz says, "I can use an IMO term to specify sidedness, such as the term 'Osteoarthritis of the left knee.' The related ICD-9 term is simply 'Osteoarthrosis, localized, primary, lower leg' versus the more specific 'Unilateral primary osteoarthritis, left knee' from ICD-10. Interestingly, there are some IMO terms that are more specific than either ICD-9 or ICD-10 nomenclatures. For example, the IMO term 'bicuspid aortic valve' maps to the more generic term of 'congenital insufficiency of aortic valve' in both ICD-9 and ICD-10. Looks like we'll be ready for ICD-11, too," Berkowitz says.
This article appears in the July 2012 issue of HealthLeaders magazine.