A group of meeting attendees, including BWH and BWFH CDI team members

On Dec. 2, BWH and BWFH hosted a New England-wide meeting of clinical documentation improvement specialists to discuss the recent implementation of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The day-long conference welcomed 55 attendees from Massachusetts, Rhode Island and Connecticut, including clinical documentation improvement nurses, program directors and physician advisors.

The meeting, called “Early Lessons from ICD-10 Implementation,” was organized by Cynthia Labins, MSN, RN, CCDS, clinical documentation improvement specialist and co-chair of the Massachusetts chapter of the Association of Clinical Documentation Improvement Specialists (ACDIS), and her BWH and BWFH clinical documentation specialist colleagues. It was held on the heels of the recent national conversion to ICD-10 as mandated by the Centers for Medicare and Medicaid Services. The classification list, which was developed by the World Health Organization (WHO), contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases. These aspects of patient care are coded to capture the acuity and resource utilization for each patient visit and submitted for reimbursement. Before the Oct. 1 conversion to ICD-10, ICD-9 had been in use since 1979.

“The meeting was a great opportunity for us to share our own experiences, challenges and best practices from the transition in our respective organizations,” said Labins. “The day yielded much valuable information about how others are faring with ICD-10.”

According to Labins, the structure of codes in ICD-10 is similar to ICD-9, but the transition was valuable because the new system allows for much more specificity about patients’ condition. With ICD-10, the number of diagnostic codes available for coding health care services went from 13,000 to 68,000. This degree of complexity allows BWH and BWFH to better describe the nature of each patient’s diagnosis and treatment. In addition, it allows organizations to capture data about symptoms, risk factors and comorbidities that can be useful in conducting research, analyzing quality and measuring outcomes.

“I am very proud of the Brigham’s implementation of ICD-10,” said Labins. “A great deal of work and preparation went into the conversion across BWH and BWFH. We were fortunate that our director, Andrea M. Kelly, JD, MSN, RN, supported us by providing numerous educational opportunities to become prepared for this transition.”

Added Kelly, program director of Clinical Documentation Improvement (CDI): “By hosting the ACDIS regional meeting, BWH and BWFH demonstrated their ongoing commitment to ensuring that the clinical complexity of our patients is reflected in the coded data. CDI nurses possess both clinical insight and a working knowledge of the new ICD-10 code set. Their leadership and collaboration in preparing for this meeting were evident in the impressive turnout, as well as in the informed and inter-professional dialogue between the nurses and coding professionals.”