Almost every major country except the United States has made the move to ICD-10, which means we can glean a lot from looking at their experiences. ICD-10 Watch community site editor Tom Sullivan speaks with Kathy DeVault, a professional practice manager at AHIMA, to discuss what the United States can learn from other countries that have already adopted ICD-10, the reasons we won't have a single coding system, and why healthcare organizations should not rely too heavily on their vendors for the ICD-10 conversion.

What lessons can the U.S. learn from countries that have already made the ICD-10 move?
CMS has recommended that coders not be trained specifically in the coding system, to sit down and code cases, until six to nine months out. So people are looking at that and going 'Well, I don't really need to do anything until January 2013.' But there's so much in the interim that needs to happen and that is what we have heard a lot from Canada, especially: 'Take the time. You have this large window of opportunity to be prepared and do the legwork for implementation.' Just sitting down and getting an implementation team together, getting all the right players to the table, and talking about all the different places, even just within the walls of your organization, that use or are impacted by the coding system, is a big deal. And I think in some organizations it might come as a surprise how many people touch those codes or use those codes in some fashion. Just identifying those and looking at the spectrum of everybody who uses codes and what kind of training they need. We know what the coders need, but then what does the data quality analyst need ? Maybe she's a nurse doing data quality abstracting. What kind of training does she need? It's really using this time appropriately to have a smoother implementation, setting your timetables.

In my reporting one possible lesson is that we should standardize the ICD-10 coding schema – is that likely or even possible?
There was some conversation in the past leading up to the final rules for ICD-10 and then in 2013 ultimately implementing ICD-10 PCS, which is the procedure portion of ICD-10. Should that replace CPT 4 and we would just have one coding system or coding schema? That was one of the reasons there was a lot of pushback and delay in getting a final rule from the government. It would be nice if we were all working in the same coding system, per se, but I don't think it'll happen. With the AMA, CPT is their product that they produce and the physicians want to keep it. So I see us moving forward with two different coding systems. We'll have ICD-10 CM and PCS and then we'll have CPT 4.

Assessing vendor readiness is another topic I've been hearing a lot about lately. Is there a prevailing sense that perhaps healthcare organizations are relying too heavily on their vendors for the ICD-10 conversion?
From what we're hearing I think there's a big reliance such as 'We don't need to worry about it, our vendors will take care of it.' But, say you're building your testing schedule for your HIPAA 5010 and for ICD-10, if you build a schedule without any awareness of where the vendors are in their process, they might not even be ready for your testing. There are huge consequences if you don't have some communication, some collaboration with your vendors. Just checking in, where are you in the process, here's our schedule, can you meet our needs with your updating schedule? So I think at this point it may not be crucial that you're right on top of your vendors but establishing that communication, really understanding where they are in the process. I think we have a tendency as customers to make assumptions about what our vendors are doing without really knowing for sure. Early awareness and early preparation will save a lot of organizations some grief in the long run if they start now on a small scale.