The health care system in the
Conservative estimates project that we will be moving from a system that contains about 14,000 diagnosis codes to a system that contains some 68,000 diagnosis codes. If youre wondering what is behind all of the angst, a little history lesson may prove beneficial.
History and Perspective
The International Classification of Diseases (or more specifically, the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, or ICD-10) is the latest in a series that has its origins in the 1850s with a collection of mortality statistics. The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893.
The World Health Organization (WHO) took over the responsibility for the ICD in 1948 when the Sixth Revision, which included causes of morbidity for the first time, was published.
The ICD is designed to promote international comparability in the collection, processing, classification and presentation of mortality and morbidity statistics. It is used to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and patient records. The reported conditions are then translated into medical codes in accordance with the classification structure and the selection and modification rules contained in the applicable revision of the ICD.
The International Conference for the Ninth Revision of the International Classification of Diseases, convened by WHO, met in
ICD and ICD-CM
So, if WHO completed the ICD-10 more than a decade ago, why hasnt it been phased in yet?
First, understand that WHOs ICD system and the system that you use for coding and billing are not one and the same. In 1979, the
Despite the annual revisions, the
ICD-10: Why, and Why Now?
Fall 2008 was exciting, to say the least, with the political change sweeping our country. In the coding world, there was much excitement as well. CMS announced that the final implementation date for the expanded ICD-10-CM (diagnosis) and ICD-10-PCS (procedure) code sets would be October 1, 2011.
In response, many health care organizations around the country protested loudly, saying that this date was too soon and that the cost and time impact of implementing the ICD-10 rules would be overwhelming to our health care system. Continued debate ensued and, earlier this year, CMS postponed the implementation date to October 1, 2013. The October 1, 2013 implementation date is a firm onein other words, ICD-9 codes cannot be used to report services performed after that date. In order to avoid entities from having to maintain the capacity to work with both coding systems after that date, the implementation of crosswalks, mapping and guidelines will enable them to move from ICD-9 to ICD-10 on and after this date.
The impetus to move to the ICD-10 comes from many different forces. The ICD-9 is 30 years old, and is outdated. Many of the diagnostic categories are full and cannot be expanded to add new entries. And, for those categories and diagnoses that do exist, many are not descriptive enough.
Specifically, ICD-9-CM includes about 14,000 diagnosis codes. Under ICD-10-CM, there will be about 68,000 codes. The number of procedure codes will increase from some 3,800 under ICD-9 to about 87,000 under ICD-10.
Also, the code structure itself will change. With the current ICD-9 diagnosis codes, each code has three to five digitsand most have five because we are obliged to always code to the highest level of specificity. There are 17 distinct chapters in the ICD-9, with all characters being numeric (except for supplemental diagnosis codesE and Vin which the first character is alpha and the remainder are numeric).
The ICD-10 is a completely different system. An ICD-10 code:
Is three to seven digits long.
Begins with an alphabetic character.
Has a numeral as the second digit.
Includes alpha or numeric digits as the third through seventh characters.
Differentiates right vs. left vs. bilateral.
ICD-9 vs. ICD-10 Glaucoma Codes 365.01 Open-angleborderline findings H40121 Low-tension glaucoma, right eye 365.12 Low-tension glaucoma
Government-produced algorithms that map a specific code from the ICD-9 to the ICD-10, or vice versa, have had limited success to date. But, Im hopeful that with time, they will become more accurate.
ICD-10 Description 365.00 Pre-glaucoma, NOS
H400 Glaucoma suspect H400 Glaucoma suspect 365.02 Anatomical narrow-angle glaucoma
H400 Glaucoma suspect 365.03 Steroid-response glaucoma
H400 Glaucoma suspect 365.04 Ocular hypertension
H400 Glaucoma suspect 365.10 Open-angle glaucoma, NOS
H4010 Unspecified open-angle glaucoma 365.11 Primary open-angle glaucoma
H4011 Primary open-angle glaucoma 365.12 Low-tension glaucoma
365.12 Low-tension glaucoma
H40122 Low-tension glaucoma, left eye 365.12 Low-tension glaucoma
H40123 Low-tension glaucoma, both eyes H40129 Low-tension glaucoma, unspecified eye
ICD-9 vs. ICD-10 Glaucoma Codes
365.01 Open-angleborderline findings
H40121 Low-tension glaucoma, right eye
365.12 Low-tension glaucoma
Benefits and Savings
There will be several major benefits to switching over to the ICD-10 system, according to the U.S. Department of Health and Human Services (HHS):
More accurate payments for new procedures.
Fewer rejected claims.
Fewer improper claims.
Better understanding of new procedures.
Improved disease management.
Better understanding of health conditions and health care outcomes.
Harmonization of disease monitoring and reporting worldwide.
In dollars and cents, benefits of the conversion to ICD-10 would start in 2013 with about $87.7 million in annual savings, according to HHS. It estimates that the cumulative benefit of the conversion will be about $3.95 billion by 2023. However, the changeover will be costly, and those costs wont break even until 2018.
Costs and Labor
The total conversion from ICD-9 to ICD-10 will cost about $1.64 billion over at least six years, HHS estimates. This total includes costs for training ($356 million), productivity losses ($572 million) and system changes ($713 million).
Cost Impact of ICD-10 for a Small Practice Costs Source: Nachimson Advisors, LLC. The impact of implementing ICD-10 on physician practices and clinical laboratories.
In every office and facility that provides health care, the changeover to the ICD-10 system will create significant challenges. These include costs and time in different areas, such as doctor and staff education and training, new claim form (Superbill) software, upgrades for practice management and billing system software, increased documentation and loss of cash flow.
Typical three-doctor practice Education
$2,405 Process analysis
$6,900 Changes to Superbills
$2,985 IT costs
$7,500 Increased documentation
$44,000 Cash flow disruption
Cost Impact of ICD-10 for a Small Practice
Source: Nachimson Advisors, LLC. The impact of implementing ICD-10 on physician practices and clinical laboratories.
One of the key issues will be having to maintain both systems in practice for at least a year while this transition is taking place. Generally, health care claims can be filed with a third-party insurer up to one year past the date of service.
Theoretically, all patients that you provide care for between October 1, 2012 and September 30, 2013 could be filed or refiled up to September 30, 2014, but you would have to use the ICD-9 diagnostic codes for these claims, as the ICD-10 wouldnt have been in force yet. This is an area of substantial concern of minesignificant delays in claims processing are conceivable.
There will be much, much more written on this topic before the October 1, 2013 implementation date. What you should do now is become familiar with the timeframe, set goals and target dates of education, work with your software manufacturers to find out how they are incorporating the ICD-10 system into their products and, most importantly, stay up-to-date by understanding where resources for the ICD-10 can be found. (See More Information on ICD-10, below.)
Theres no doubt in anyones mind that our industry is a dynamic one. The world of coding is no different. Change occurs on a daily basis, whether its in a reimbursement value, a new rule or regulation, or interpretation thereof that places the practitioner at risk.
They say that the path of change is a bumpy one. The
In the end, we should have a system that is more accurate, more descriptive, allows for better reimbursements, and keeps us as a country current on the world stage.
Stay tuned for further developments as we go on this journey together.
More Information on ICD-10 General ICD-10 information ICD-10 Notice of Proposed Rulemaking ICD-10-CM information and equivalence mappings for ICD-9-CM to ICD-10-CM ICD-10-CM/PCS to ICD-9-CM reimbursement mappings
More Information on ICD-10
General ICD-10 information
ICD-10 Notice of Proposed Rulemaking
ICD-10-CM information and equivalence mappings for ICD-9-CM to ICD-10-CM
ICD-10-CM/PCS to ICD-9-CM reimbursement mappings