The Electronic Changeover

“For a system like VA or DoD, it’s overwhelming,” explained Kyle Dennis, PhD, deputy director of VA’s Audiology and Speech Pathology Service. “Just determining how many different software systems and databases and health records contain these codes is overwhelming. There are hundreds and hundreds and hundreds of these applications in a healthcare system like VA. They have to be catalogued and identified, and those systems have to be programmed so they can take advantage of the code set. It’s an enormous task.”

Dennis has been toiling behind the scenes on the changeover. He has consulted with the project group at VA headquarters on the switch and has been working to prepare physicians in his service for the change. While he says he is certain VA is up to the task, he has no illusions about how difficult it will be.

“The transition date is October 1, 2013. There’s not going to be any grandfathering. There will be no systems using both systems. That’s it,” he said. “That seems like a little bit of time away, but it isn’t.”

The first big step for VA is on Jan. 1, 2012, when all of the billing software will switch over to a new version to allow ICD-10 coding. Once that is in place, more comprehensive changeover in electronic systems can begin. 

The Human Challenge

The real challenge will occur outside the digital realm, however. Every healthcare provider in the VA system who uses coding will need ICD-10 training.

“Most of the coders and health IT specialists have already gone through this training,” Dennis said. “But most clinicians don’t know about this yet.”

How that training will occur — whether in on-site classes or online seminars — is unknown. Also, different specialties may need different  training levels. Physicians who use both the disease coding part of the ICD system and the inpatient-procedure coding part will have to learn two new coding systems at once.

Most physicians have known no other method. Those who have used ICD-9 the longest might struggle most with the switchover, Dennis said. However, the greatest challenge might be for physicians fresh out of medical school. They will have to learn ICD-9 for the immediate future, as well as ICD-10 for the post-Oct. 1, 2013, world.

Another layer of difficulty for VA is its close partnership with DoD. Because the two systems are linked, with patients transferring directly from one healthcare system to the other, the changeover from ICD-9 to ICD-10 must occur in tandem.

“We have to make sure that while we’re transitioning we don't shut something off because an agency in DoD isn’t ready,” Dennis said.

While those working on the project have a grasp of what looms before them, most physicians remain unaware. “In our specialty, we’ve been working with this for a couple of years getting ready,” Dennis said. “Of course, I’m assuming people have been listening. Sometimes people don’t listen to things that affect them until it’s really affecting them.

“The average clinician may have heard about the changeover, but I don’t think most have gotten a clear understanding about all the things they’ll actually have to do,” he added. “It’s like learning a new language, and you’re not going to be conversant immediately. There’s going to be a period where people think in ICD-9 terminology and have to struggle to remember the ICD-10 code. It’s going to be a real challenge for a lot of people.”

Centers for Medicare & Medicaid Services

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