Why prepare for ICD-10?

The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets on October 1, 2015. ICD-10 consists of two parts:

• ICD-10-CM diagnosis coding which is for use in all U.S. health care settings.
• ICD-10-PCS inpatient procedure coding which is for use in U.S. hospital settings.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims:

• Claims for services provided on or after the compliance date should be submitted with ICD-10 diagnosis codes.
• Claims for services provided prior to the compliance date should be submitted with ICD-9 diagnosis codes.

The change to ICD-10 does not affect CPT coding for outpatient procedures.

ICD-9 to ICD-10

More than an update, a leap in how we define care.

Modern History of the Medical Dictionary—ICD-10

The World Health Organization’s (WHO) International Classification of Diseases has served the healthcare community for over a century. The United States implemented the current version (ICD-9) in 1979. While most industrialized countries moved to ICD-10 several years ago, the United States is just now transitioning with a final compliance date of October 1, 2015. It’s time our Medical Dictionary reflected modern medicine.

By Physicians for Physicians

Under the sponsorship of the WHO, a select group of physicians created the basic ICD-10 structure. Following this, each physician specialty within the United States offered their input on the subset of diagnosis codes required. In most cases, the specialties advocated capturing additional detail based on information that physicians intuitively use in delivering patient care.

These changes enhance current medical documentation standards to capture a greater level of detail in patient care. Accurate analysis of health data will help improve the quality and efficiency of delivering patient care, particularly as electronic sharing and exchange of health records grows.

 

Reasons to prepare for ICD-10 can be broken down into four categories:

Clinical		Informs better clinical decisions as better data is documented, collected, and evaluated Provides new insights into patients and clinical care due to greater specificity, laterality, and more detailed documentation of patient diseases Enables patient segmentation to improve care for higher acuity patients Improves design of protocols and clinical pathways for various health conditions Improves tracking of illnesses and severity over time Improves public health reporting and helps to track and evaluate the risk of adverse public health events Drives greater opportunity for research, clinical trials, and epidemiological studies
Operational		Enhances the definition of patient conditions, providing improved matching of professional resources and care teams and increasing communications between providers Affords more targeted capital investment to meet practice needs through better specificity of patient conditions Supports practice transition to risk-sharing models with more precise data for patients and populations
Professional		Provides clear objective data for credentialing and privileges Captures more specific and objective data to support professional Maintenance of Certification reporting across specialties Improves specificity of measures for quality and efficiency reporting Aids in the prevention and detection of healthcare fraud and abuse Provides more specific data to support physician advocacy of health and public health policy
Financial		Allows better documentation of patient complexity and level of care, supporting reimbursement for care provided Provides objective data for peer comparison and utilization benchmarking May reduce audit risk exposure by encouraging the use of diagnosis codes with a greater degree of specificity as supported by the clinical documentation

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