A Beginner’s Guide to the ICD-10 Transition
Written by Shannon Sakewski
The US health care industry has recently been preparing to transition to an updated medical coding structure; a feat which hasn’t been attempted in over three decades. Completion of the transition to ICD-10 in the US must be complete by October 1, 2015. Anyone subject to HIPAA requirements—not just those who submit claims to Medicare or Medicaid—will be required to transition.
The US lags several years behind other countries in its implementation of ICD-10. Though this lag is a source of some tension among health industry stakeholders, American health professionals have a great deal of information at their disposal regarding implementation strategies.
What is ICD-10?
The International Classification of Diseases (ICD), regularly revised by the World Health Organization, is the most widely applied healthcare classification system. The 10th Edition (ICD-10) consists of two parts. ICD-10-CM (Clinical Modification) is used for diagnosis coding in all health care settings. ICD-10-PCS (Procedure Coding System) is for use in in-patient settings only.
Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, ICD-9-CM is the designated code set. However, ICD-9 was first implemented in the US approximately 35 years ago. It is now obsolete. There are numerous problems with the continuing use of ICD-9, including:
- Diagnosis codes are not sufficiently specific to describe the complexity of some diseases and conditions.
- Sharing meaningful healthcare data across borders is problematic given that many countries have already transitioned to ICD-10, or a clinical modification thereof. Even in the US, mortality statistics have been analyzed using the tenth revision since 1999.
- The ability to assign new codes is hindered or impossible due to the fact that few Tabular List numbers are currently available.
- Given these aforementioned issues, it is therefore less than ideal to effectively monitor health care utilization, performance, and outcomes using ICD-9 classifications.
So, why does the US continue to use ICD-9? Put simply, transitioning to ICD-10 is complicated and costly. Many debate whether the benefits of transitioning will outweigh the costs.
How do I prepare?
Since transitioning something so foundational to health practices is, indeed, complicated and potentially costly, it is important to begin the process as soon as feasible. Many larger provider organizations have already made progress in their transition process. Smaller practices may have significant progress to make in order to meet the October 1, 2015 transition deadline.
Where does your organization fall in terms of preparation for ICD-10? If you have some work to do, begin by assessing the potential impact of transitioning on your organization. Based on these observations, develop an implementation strategy, including a timeline and budget. If your organization uses the services of a vendor (e.g., billing service, software provider, etc.), check with them to learn about their transition plans. If your organization handles software development, billing, and other functions internally, coordination should begin now with medical records, clinical, IT, finance, and other necessary teams.
Payers should have an implementation plan and budget in place, but are likely still in the process of reviewing payment policies to ensure that they will align with the new coding structure. Regardless, payers should also be in consistent contact with all relevant vendors to ensure that the implementation process is as smooth as possible.
Vendors who work with both payers and providers should be sure that lines of communication with clients are open and active. Be proactive in assisting clients so that they can ensure swift claim payments. This transition is an excellent business opportunity for vendors who are willing to take steps to ensure their relevance. Without preparation, there is an increased risk of obsolescence.
Need more information?
If this overview of the ICD-10 overview has left you curious to learn more, the following resources may be helpful to you:
- ICD-10 FAQs from CMS
- ICD-10 resources from CMS
- Health Affairs Issue Brief: “Transitioning to ICD-10”
- Issues and challenges article from American Health Information Management Association
Shannon Saksewski has been practicing and studying health strategy in multiple contexts for more than five years. She earned a BA in psychology and studies in religion, a MSW focused on counseling practice, and a MBA focused on health strategy from the University of Michigan. Shannon can be reached via email (firstname.lastname@example.org), Twitter (@ssaksews), or LinkedIn.
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