ICD-10 preparation must begin now

August 1, 2009
Angela Boynton
Angela Boynton

The United Kingdom implemented ICD-10 as far back as 1995, making the United States one of the last major global economies to begin the implementation process.

Disease classification has existed since the 1890s when French physicians recognized the need to be able to track disease outbreak, progression, and mortality. In the past 110 years, there have been new diseases, discoveries, and advances in treatments, yet little has changed in the way that disease classification is employed. We still rely on disease classification for reporting things such as disease monitoring, outbreak, progression, morbidity and mortality statistics, and more recently, for reimbursement.

In the late 1970s, the United States began using ICD-9 for disease classification. Almost immediately after its implementation, work began on a successor: ICD-10. The ICD-10 code set is officially known as the International Classification of Diseases 10th Revision with Clinical Modification. The code set is developed and maintained primarily by the World Health Organization, and its current ICD-10 system has a level of logic never before seen in the coding industry.

In Spring 2009, the Centers for Medicare and Medicaid Services (CMS) opened a new chapter for disease classification when it announced that ICD-10-CM will be implemented on a national level. Compliance is mandated for October 1, 2013; this date has been locked in by the federal government. In other words, there will be no extensions. This means that managed care must begin organizing its implementation efforts now.

The benefits of the ICD-10 conversion focus largely on increased reimbursement accuracy, greater code specificity, and increased room for expansion. ICD-10 also offers a greater degree of clinical logic that will be vital as the nation moves closer toward the electronic health record as the documentation standard.

ICD-9, by contrast, is quickly running out of room, making it difficult for the code set to keep up with advances. In addition, some of the diseases contained in ICD-9 are outdated. Old and obsolete codes lead to inaccuracy in data reporting and statistical tracking, and a lack of specificity leads to inaccurate reimbursement.

In comparing ICD-9 to ICD-10 there are marked contrasts. Currently ICD-9 has a three- to five-character format, where the first digit may be alpha-numeric to account for codes that may begin with the letters E, V, or M. ICD-10 has a three- to seven-character format: the first character is alpha, characters 2 and 3 are numeric, and characters 4-7 can be alpha-numeric. In total, ICD-9-CM has roughly 13,000 codes. This number increases to 68,000 in the ICD-10 code set-a nearly 5 to 1 increase.

The ICD-10 code set is divided into two major sections: ICD-10-CM represents disease classification, where as ICD-10-PCS contains procedure codes. ICD-10-PCS is designed to replace the existing ICD-9 procedure codes, currently, at roughly 3,000 codes. These codes are used mainly in hospital reporting. The number of codes increases to 78,000 in ICD-10-PCS-a 26 to 1 increase.

The sheer increase in the volume of codes found in ICD-10 will allow for increased specificity in coding, which in turn will lead to more accurate data reporting and reimbursement.

For example, currently in ICD-9 there is only one code to represent decubitus ulcers, or pressure sores, and it does not specify complications or degrees of severity. Compare that with ICD-10, where there are eight codes representing decubitus ulcers to classify varying degrees of severity, as well as complications. On a larger scale, the increased specificity will enable more accurate reimbursement, and allow health plans to have a better grasp on severity of illness.

There have been comparisons made between the coming ICD-10 code set change and the Y2K phenomenon leading up to the year 2000. The end result of the Y2K transition is well known: When the year 2000 arrived, there were few long-term effects as a result of the date change. This can be attributed to the level of preparedness; as a society we were ready for the change.