ICD-10

The US Department of Health and Human Services has mandated that after October 1, 2015, all HIPAA covered entities must transition from using International Classification of Diseases version 9 (ICD- 9) codes to using version 10 (ICD-10) codes (www.cms.gov). This will impact public health surveillance entities that receive, analyze, and report ICD-9 encoded data. Public health agencies will need to modify existing database structures, extraction rules, and messaging guides, as well as syndrome definitions and underlying analytics, statistical methodologies, and business rules. Implementation challenges include resources, funding, workforce capabilities, and time constraints for code translation and syndrome reclassification.

Objective

To describe the process undertaken to translate syndromic surveillance syndromes and sub-syndromes from ICD-9 diagnostic codes to ICD-10 codes and how these translations can be used to improve syndromic surveillance practice.

The compliance date for the ICD9-ICD10 transition is October 1, 2015. The hospitals have started the ICD9-ICD10 transition. However, not all data providers will transition the data at the same time. In order to facilitate some coherence to the data during this transition period, user interface and data processing functionalities have been developed in ESSENCE to allow usage of both classification systems simultaneously. This capability will allow users to perform ICD10- based queries across all the hospitals in their system, irrespective of the exact number of hospitals that have completed the ICD10 transition.

Objective

To help users seamlessly query and analyze data in disease surveillance systems using both ICD9 and ICD10 codes during the transition period. Additionally, the mappings between ICD9 and ICD10 codes must be flexible enough to support locally required changes based upon a user’s needs.

This roundtable provided a forum for a diverse set of representatives from the local, state, federal and international public health care sectors to share tools, resources, experiences, and promising practices regarding the potential impact of the transition on their surveillance activities. This forum will promote the sharing of lessons learned, foster collaborations, and facilitate the reuse of existing resources without having to 'reinvent the wheel.' It is hope that this roundtable will lay the ground-work for a more formal, collaborative, and sustainable venue within ISDS to aid in preparing the public health surveillance community for the coming ICD-9/10 CM transition.

NC DETECT receives ICD-9-CM codes for emergency department (ED) visits and uses these codes in case definitions for syndromic surveillance (e.g. infectious disease, injury, etc.). Hospitals will begin using ICD-10-CM codes on October 1, 2015. As a result, preparations have been made to accommodate ICD-10-CM codes in NC DETECT for data transmission, receipt, processing and use in the NC DETECT Web Application.

Objective

To describe lessons learned from the transition to ICD-10-CM.

On October 1, 2015, the number of ICD codes will expand from 14,000 in version 9 to 68,000 in version 10. The new code set will increase the specificity of reporting, allowing more information to be conveyed in a single code. It is anticipated that the conversion will have a significant impact on public health surveillance by enhancing the capture of reportable diseases, injuries, and conditions of public health importance that have traditionally been the target of syndromic surveillance monitoring. For public health departments, the upcoming conversion poses a number of challenges, including: 1) Constraints in allocating resources to modify existing systems to accommodate the new code set, 2) Lack of ICD-10 expertise and training to identify which codes are most appropriate for surveillance, 3) Mapping syndrome definitions across code sets, 4) Limited understanding of the precise ICD-10 CM codes that will be used in the US Healthcare system, and 5) Adjusting for changes in trends over time that are due to transitions in usage of codes by providers and billing systems. To accommodate the ICD-9 to ICD-10 transition, the Centers of Disease Control and Prevention (CDC) partnered with the International Society of Disease Surveillance (ISDS) CoP to form a workgroup to develop the Master Mapping Reference Table (MMRT). This tool maps over 130 syndromes across the two coding systems to assist agencies in modifying existing database structures, extraction rules, and messaging guides, as well as revising established syndromic surveillance definitions and underlying analytic and business rules.

Objective

This roundtable will provide a forum for the syndromic surveillance Community of Practice (CoP) to discuss the public health impacts from the ICD-10-CM conversion, and to support jurisdictional public health practices with this transition. It will be an opportunity to discuss key impacts on disease surveillance and implementation challenges; and identify solutions, best practices, and needs for technical assistance.

As of October 1, 2015, all HIPAA covered entities transition from the use of International Classification of Diseases version 9 (ICD-9-CM) to version 10 (ICD-10-CM/PCS). Many Public Health surveillance entities receive, interpret, analyze, and report ICD-9 encoded data, which will all be significantly impacted by the transition. Public health agencies will need to modify existing database structures, extraction rules, and messaging guides, as well as revise established syndromic surveillance definitions and underlying analytic and business rules to accommodate this transition. Implementation challenges include resource, funding, and time constraints for code translation and syndrome classification, and developing statistical methodologies to accommodate changes to coding practices.

To address these challenges, the International Society for Disease Surveillance (ISDS), in consultation with the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE), has conducted a project to develop consensus-driven syndrome definitions based on ICD- 10-CM codes. The goal was to have the newly created ICD-9-CM to-ICD-10-CM mappings and corresponding syndromic definitions fully reviewed and vetted by the syndromic surveillance community, which relies on these codes for routine surveillance, as well as for research purposes. The mappings may be leveraged by other federal, state, and local public health entities to better prepare and improve the surveillance, analytics, and reporting activities impacted by the ICD-10-CM transition.

Objective

To describe the process undertaken to translate syndromic surveillance syndromes and sub-syndromes consisting of ICD-9 CM diagnostic codes to syndromes and sub-syndromes consisting of ICD-10-CM codes, and how these translations can be used to improve syndromic surveillance practice.