ICD-10: A Short Story
By: Sajeesh Jinaraj
ICD-10-CM is the 10th revision of an international coding system used around the world, the International Classification of Diseases. The United States, which as of now uses ICD-9, will be one of the last developed nations to move to ICD-10, which much of the world has been utilizing for over 12 years.
ICD-10 is a product of the World Health Organization (WHO) designed for official collection of diagnostic data. The United States uses the ICD system to code diagnoses for all healthcare encounters. When ICD codes are tied to the American Medical Association’s (AMA) Common Procedure Terminology (CPT) codes, appropriate payment can be returned to the practicing physician.
It is important to understand the major improvements and changes between ICD-9 and ICD-10 diagnosis codes.
|ICD-9-CM Diagnosis Codes||ICD-10-CM Diagnosis Codes|
|No-Laterality||Laterality -Right or Left account for >40% of codes|
|3-5 digits||7 digits|
|First digit is alpha (E or V) or numeric||Digit 1 is alpha; Digit 2 is numeric|
|Digits 2-5 are numeric||Digits 3–7 are alpha or numeric|
|No placeholder characters||“X” placeholders|
|14,000 codes||69,000 codes to better capture specificity|
|Limited Severity Parameters||Extensive Severity Parameters|
|Limited Combination Codes||Extensive Combination Codes to better capture complexity|
|1 type of Excludes Notes||2 types of Excludes Notes|
- Importance of Anatomy: Injuries are grouped by anatomical site rather than by type of injury.
- Incorporation of E and V Codes: The codes corresponding to ICD-9-CM V codes (Factors Influencing Health Status and Contact with Health Services) and E codes (External Causes of Injury and Poisoning) are incorporated into the main classification rather than separated into supplementary classifications as they were in ICD-9-CM.
- New Definitions: In some instances, new code definitions are provided, reflecting modern medical practice (e.g., definition of acute myocardial infarction is now 4 weeks rather than 8 weeks).
- Restructuring and Reorganization: Category restructuring and code reorganization have occurred in a number of ICD-10-CM chapters, resulting in the classification of certain diseases and disorders that are different from ICD-9-CM.
- Reclassification: Certain diseases have been reclassified to different chapters or sections in order to reflect current medical knowledge.
Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS, which handles procedure codes, will provide higher-quality information for measuring healthcare service quality, safety, and efficacy. This will give better information to:
- Quality measurement and medical error reduction (patient safety).
- Outcomes measurement.
- Clinical research.
- Clinical, financial, and administrative performance measurement.
- Health policy planning.
- Operational and strategic planning and healthcare delivery systems design.
- Payment systems design and claims processing.
- Reporting on use and effects of new medical technology.
- Provider profiling.
- Refinements to current reimbursement systems, such as severity-adjusted DRG systems.
- Pay-for-performance programs.
- Public health and bioterrorism monitoring.
- Managing care and disease processes.
- Educating consumers on costs and outcomes of treatment options.
Moving to the new code sets will also permit improved efficiencies and lower administrative expenses as a result of replacing a dysfunctional classification system. In turn, this allows:
- Increased use of automated tools to facilitate the coding process.
- Decreased claims submission or claims adjudication costs.
- Fewer rejected and improper reimbursement claims.
- Greater interoperability.
- Decreased need for manual review of health records to meet the information needs of payers, researchers, and other data mining purposes.
- Decreased need for large research organizations to maintain dual classification systems (one for reimbursement and one for research).
- Reduced coding errors.
- Reduced labour costs and increased productivity.
- Increased ability to prevent and detect healthcare fraud and abuse.
It has become clear that the benefits far outweigh the costs of implementation by evaluating the dollar estimation of the advantages in the following categories:
- More accurate payment for new procedures.
- Fewer rejected claims.
- Fewer fraudulent claims.
- Better understanding of new procedures.
- Improved disease management.
The transition will be tough. Even the well prepared office may run into problems directly following the transition. Be prepared to see a decrease in productivity and accuracy, as well as the need for additional training and education. Expect delays in claims processing and an increase in the number of rejected claims, but to continue with the quotable theme “no pain, no gain.” It is our responsibility to propel the healthcare industry forward, and ICD-10 is a very important step in that process.
As a broad outline, the following 8 steps will help ensure successful implementation of ICD-10 this year:
- Engage a team:The transition team should be headed by a physician and include the practice executive, coders, other office staff and medical assistants. Those who document the medical record must be involved and begin training soon.
- Establish a plan and then Execute it:These are multiple plans, including one for education and training, one for assessing current documentation, one for conducting a gap analysis, and one for implementation. Watch for and participate in the AAOS educational program on ICD-10 transition and implementation this year. Once the plans are made, execute them.
- Conduct a gap analysis:A skilled consultant or team should take the top 25 to 40 diagnoses seen in the practice. Using current documentation, the team should code the same cases to ICD-10-CM, and see what is missing.
- Get focused training:Send office staff to a seminar or hire a consultant to do specific onsite training, focused on orthopaedics and any specialty area of the practice.
- Follow through:Do this particularly on the clinical documentation improvement plan. Make the changes in your electronic health record system template. Capture the data you need for the specific and best code to be selected.
- Identify ICD code usage: Where does your practice use ICD codes? Identify all places where you use ICD codes, because all will need to be changed. Take advantage of the opportunity to make process improvements.
- Continue testing: Training is not a one-time exertion; it must be consistent.
- Champion the change: Be the physician champion in your office who is supportive of this change and demonstrate your ability to give a detailed diagnosis or diagnoses for coding.
This is not a Heart-breaking situation, and there is no reason to panic. Good clinical documentation is the foundation, and having coders trained in ICD-10-CM will help through the transition.
- 6 Benefits of Integrating ICD-10 Codes.
- ICD-10 Definition.
- ICD-10 Code Set to Replace ICD-9.
- ICD-10 Taskforce Bulletin.
- ICD-10-CM: It Is Not All That Bad
- Successful ICD-10 Testing Shows Industry Ready to Take Next Step to Modernize Health Care
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