ICD-9 to ICD-10: An Upgrade

The year 2014 is bringing a lot of changes for the health care industry, including the ICD-10 compliance date. ICD is the classification used to code and classify diseases. The ICD has been revised periodically to incorporate changes in the medical field. To date, there have been 10 revisions of the ICD. On October 1st, 2014 all of the ICD-9 code sets that were previously used will be replaced by ICD-10 code sets. This transition is required for everyone covered by HIPAA.

ICD-10, or International Classification of Diseases, 10th Edition, consists of two parts: ICD-10-CM for diagnosis coding and ICD-10-PCS for inpatient procedure coding. The Centers for Medicare & Medicaid Services website (CMS.GOV) states that the transition needs to happen because the 30-year-old ICD-9 code list contains outdated terms and is inconsistent with current medical practice. Most other nations using ICD-9 codes have already made the transition to ICD-10. ICD-10 codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. According to the second installment of Navicure’s ICD-10 readiness survey, 50% of all practices have indicated their intention to wait until May 2014 to start making ICD -10 preparations. Respondents of the survey indicated that revenue and cash flow losses were their greatest concerns.

The Centers for Medicare & Medicaid make the following recommendations:

Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and budget. Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans.

Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT, and finance staff to coordinate on ICD-10 transition efforts.

While many are concerned about the increased number of codes in ICD-10–the number  will increase from 17,000 to 141,000–this greater level of detail is actually the main benefit. ICD-10 includes nearly eight times as many codes as ICD-9, and these more detailed codes are designed to improve the ability to measure quality, safety, and efficacy of care. The code changes will also allow for higher-quality data analysis. On top of greater efficiency, the new coding system will allow physicians to accurately report the complex care that they provide rather than billing as “unspecified,” which will lead to a higher reimbursement value.

According to the National Health Care Anti-Fraud Association, it is estimated that the financial losses due to healthcare fraud are in the tens of billions of dollars each year. ICD-10 will likely lower the number of fraudulent and exaggerated claims that drive up healthcare cost for all. After the transition period to ICD-10, the algorithms used by payers to detect fraud will be gradually refined to spot the patterns of legitimate billing. The availability of more detailed data will allow for improved strategies for investigation into potential fraud.

Health Monitoring Systems is currently ready to receive ICD-10 as soon as facilities are capable of providing it. We look forward to seeing the positive changes that may result from the transition to ICD-10 and will be watching closely to see how things develop.