ICD-10: A Change in Healthcare IT

October 1^st, 2014 is the cut-off for all physicians and insurers to switch over to ICD-10 from ICD-9. The International Statistical Classification of Diseases & Related Health Problems (ICD) is a medical classification list created by the World Health Organization. Its purpose is to use codes to identify known diseases and other health issues. ICD also helps with the retrieval and storage of diagnostic information and will classify and code all diagnoses, procedures, and symptoms that are recorded in conjunction with hospital care. The transition to ICD-10 is taking place because data about patients’ medical conditions and hospital inpatient procedures on ICD-9 is limited. This change will affect everyone covered by the Health Insurance Portability Accountability Act (HIPAA).

For most, ICD-10 coding has been used for years, but the push will ensure every United States practice is uniform. Those who do not code correctly after the October 1^st deadline will face penalties including denial of claims, which will likely force them to re-submit. This will dramatically slow reimbursement times and cash flow, leaving physicians’ offices with major operational inefficiencies. The ICD-10-CM revision includes more than 68,000 diagnostic codes, up from a previous 13,000 codes in IDC-9-CM, allowing physicians to provide more specific details in documentation. ICD-10 will provide details to ensure that reimbursements match the level of care actually given, along with accuracy in patient documentation to allow improved care. Changes to be aware of include laterality, disease pathophysiology, combination codes, encounter timing, identification of trimester, increased disease specificity, alcohol and drug abuse, expansion of injury codes, and post-procedure disorders.

Healthcare IT professionals can prepare for this change through an ICD-10 impact assessment by identifying systems, applications, and software that currently uses ICD-9 code and evaluating each step to see where ICD-10 codes will be needed. They should talk with their software and service vendors to get the conversation going about where they are in their transition to ICD-10, asking questions such as: How does this impact the software? Where are you in the transition process?  How are we going to reach full compliance? Training, coordination, and education to prepare for ICD-10 are very important. A clinical documentation improvement (CDI) documentation gap analysis should also be applied to super bills, charts, etc. Once a good ICD-10 impact assessment is completed, an accurate budget can be planned. Although some might struggle with the switch at first, once implemented, ICD-10 is expected to improve quality measures, reporting, and regulatory compliance.