For those well versed in ICD-9, learning ICD-10 may be akin to learning a second language. Many coders say their biggest fear about the new system that will take effect October 1, 2013 is that it requires a different coding logic (particularly ICD-10-PCS), but that it's also so much more specific than ICD-9.

It's no wonder why coders feel this way. In ICD-9, there are 14,025 codes from which to choose. In ICD-10, this number is nearly five times that amount (68,069). Coders' fear of greater specificity is even more warranted given the oftentimes sparse or unspecified physician documentation from which they must assign diagnosis codes.

The good news is that CMS is working toward creating a general equivalence map (GEM) between the two systems that will help coders and others understand how codes in ICD-9 will translate to ICD-10.

The GEMs will serve as a reference for how one ICD-9 code may map to a series of ICD-10 codes or vice versa, says Shannon McCall, RHIA, CCS, CCS-P, CPC, director of coding and HIM for HCPro, Inc., in Chesterfield, VA. "The GEM is only a map—not a crosswalk," she says. "There will not necessarily be a one-to-one translation from ICD-9 to ICD-10," she adds.

However, the GEMs are important in terms of data quality and preservation, she says. "It's not just about implementing a revised classification system and forgetting about the previous version. Many projects like auditing and retrospective reviews will still require flexibility in referencing the correct coding classification system used for the dates of services," she says. "We also don't want to lose 30 years worth of data by moving to a new system in which we scrap everything else."

The process of mapping ICD-9 to ICD-10 will surely prove to be no small task, but it is a necessary step in ensuring a smooth transition between the two coding systems. CMS reiterates the importance of moving to ICD-10 and outlines its plans to map the new system with ICD-9 in several recently released publications, including a General Equivalence Mapping: Top 10 Question and Answer Fact Sheet as well as an ICD-10 User Guide.

In its Fact Sheet, CMS says the intended audiences for the GEMs are coding professionals, payers, providers, medical researchers, informatics professionals, and any other individuals who use coded data. These individuals can use the GEMs to convert payment systems, payment and coverage edits, risk adjustment logic, quality measures, and a variety of research applications that involve trend data.

CMS will also hold a national provider conference call about the GEMs on May 19 from 1 p.m. to 2:30 p.m. EST. CMS has provided downloadable presentation materials. The conference call will discuss the following:

• An overview of the ICD-10 final rule, which requires the implementation of
• ICD-10-CM/PCS on October 1, 2013
• The differences between ICD-9-CM and ICD-10-CM/PCS codes
• The use of the General Equivalence Mappings that have been created to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS
• The resources that are available to assist in planning for the transition from ICD-9-CM to ICD-10-CM/PCS

The ICD-9-CM Coordination and Maintenance Committee will discuss updating the GEMs for a minimum of three years after ICD-10 is implemented on October 1, 2013.

Lisa Eramo, CPC is a senior managing editor in the health information management division of HCPro, Inc. She is located in Rhode Island and writes content for the company's flagship newsletter, Medical Records Briefing.

Researchers at Boston Medical Center (BMC) are investigating whether a virtual patient advocate can improve real-life health literacy.

Developed by Timothy Bickmore, PhD, assistant professor of computer and information science at Northeastern University in Boston, the virtual patient advocate is on clinical trial at BMC to increase patient understanding of post-discharge self-care regimens. Bickmore and his team of researchers hope the system can decrease patient readmissions within 30 days of hospital discharge.

"Nationally it's been shown that about 20% of patients get readmitted within 30 days," says Bickmore, who adds that a third of that percentage are preventable. "There is a lot of information patients need to know before they go home. The typical discharge in the U.S. lasts about eight minutes and it's like 'here are your prescriptions and a pat on the back.'"

According to the U.S. Department of Education's 2003 National Assessment of Adult Literacy, 36% of the U.S. adult population has only basic or below basic health literacy levels. And while the virtual patient advocate doesn't have a medical or nursing degree, or even a pulse, she can provide patients with the information they need to know—via a computer. She can also devote all of her time to doing so.

The system operates by having a clinical trial nurse enter a predischarge patient's information into a computer database. This generates an "After-Hospital Care Plan" personalized booklet for the patient. After that, the nurse wheels the computer to the patient's bedside on a kiosk and gives the patient his or her pamphlet. The patient then converses with an animated virtual patient advocate character using a touch-screen display to go over their care instructions.

The system enables the patient to review his or her medication list, follow-up appointments, primary diagnosis, pending lab tests, medical durable equipment needed at home, and diet and exercise recommendations. It also creates a list of questions the patient can review with a nurse at the end of the interaction.

In addition, the pamphlet features a patient activation page that encourages patients to write down questions and issues they may want to discuss with their primary care physician prior to the actual visit.

To date, 220 patients have participated in the three-year clinical trial of the virtual patient advocate that began at BMC in fall 2008, which will conclude after enrolling 750 patients. These patients are getting 40 minutes on average and sometimes more than an hour, depending on the number of medications they are taking, to go over their care instructions, says Bickmore.

Researchers have already compiled data showing that low health literacy patients find the system user-friendly, and sometimes even preferable to receiving the information from a physician or nurse.

"What I find most helpful is the ability of the virtual patient advocate to drill down to patients' concerns," says Lynn Schipelliti, RN, who is participating in the study at BMC. "I see it as an asset to healthcare. Patients are going home sicker and have multiple medical problems to manage at home. Talking about discharge when patients are admitted allows them time to think beyond today and what it will be like when they go home."

Ultimately, it is the human-like nature of the virtual patient advocate that seems to increase the effectiveness and understanding of patients' care plans.

"The virtual patient advocate is patient and kind, shows empathy and humor, has medical knowledge, and shows confidence. All of these things make her believable and trustworthy to patients," Schipelliti says. "They appreciate the private time they are allowed to listen and ask questions—and that they decide when they have had enough."

The research for the virtual patient advocate is sponsored by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

In a report, the Institute of Medicine said doctors should stop taking much of the money, gifts, and free drug samples they routinely accept from drug and device companies. The report is a stinging indictment of many of the most common means by which drug and device makers endear themselves to doctors, medical schools, and hospitals. It is even more damning than a similar one released last year by the Association of American Medical Colleges, which proposed tough new rules governing interactions between companies and medical schools.

Minnesota regulators have cited Regions Hospital in St. Paul for neglect of care in the case of a patient who died last year after suffering brain damage. In a report, investigators from the Minnesota Department of Health said hospital staff members chose to silence the alarm on a device monitoring the patient's oxygen level "rather than make a proper assessment" of the patient's condition. Because Regions has taken corrective action, however, the state did not issue a licensing "deficiency," a penalty that, in rare cases, could lead to loss of eligibility for state and federal reimbursements.