It’s an exciting time of healthcare reform for the United States and a lot of that excitement revolves around the transition from ICD-9 to ICD-10. If you’re asking yourself what is ICD-10, then you've come to the right place.
ICD-10 or a clinical modification of ICD-10 is the classification system currently being used by the majority of the world. The US is the only industrialized nation not using an ICD-10-based classification system.
There are two main reasons that the transition to ICD-10-CM/PCS is necessary:
Payors cannot pay claims fairly using ICD-9-CM since the classification system does not accurately reflect current technology and medical treatment. Significantly different procedures are assigned to a single ICD-9-CM procedure code. Limitations in the coding system translate directly into limitations in the diagnosis-related groups (DRG).
The healthcare industry cannot accurately measure quality of care using ICD-9-CM. It is difficult to evaluate the outcome of new procedures and emerging health care conditions when there are not precise codes. Most importantly, we have a mission to improve our ability to measure health care services provided to our patients, enhance clinical decision-making, track public health issues, conduct medical research, identify fraud and abuse and design our payment systems to ensure services are appropriately paid.
You can get a basic introduction to ICD-10 in this MLN Connects Video on the CMS YouTube Channel featuring Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance at AHIMA.
ICD-10-CM is a clinical modification of the World Health Organization’s ICD-10, which consist of a diagnostics classification system. ICD-10-CM includes the level of detail needed for morbidity classification and diagnostics specificity in the United States. It also provides code titles and language that compliment accepted clinical practice in the US. The system consist of more than 68,000 diagnosis codes
ICD-10-PCS was developed to capture procedure codes. This procedure coding system is much more detailed and specific than the short volume of procedure code included in ICD-9-CM. The system consists of 87,000 procedure codes.
Together ICD-10-CM and ICD-10-PCS have the potential to reveal more about quality of care, so that data can be used in a more meaningful way to better track the outcomes of care. ICD-10-CM/PCS incorporate greater specificity and clinical detail to provide information for clinical decision making and outcomes research.
There are many reasons why the transition to ICD-10 is important. ICD-10 will provide us with:
Additionally the benefits of ICD-10 outweigh the costs
An independent study conducted by RAND concluded that the benefits of ICD-10-CM/PCS are likely to exceed initial implementation costs within just a few years. Furthermore, the cost of doing nothing may be greater than the actual implementation. Any delay in adoption of ICD-10-CM/PCS will cause an increase in future implementation costs as the management of health information becomes increasingly electronic and the costs of implementing new coding systems increase due to required systems and application upgrades.
There are a number of areas within the ICD-9-CM where the country could benefit from the greater detail provided by having more extensive codes. While there is greater specificity offered in the majority of the ICD-10-PCS codes, there will continue to be options for broader, generalized codes when the specific details regarding a patient's condition may not be known or documented. Additionally, the ICD-9-CM classification has not kept up with medical knowledge. Some examples are as follows:
Example: ICD-9-CM does not accurately reflect current technology and medical treatment. Since ICD-9-CM does not accurately describe advancements in technologies, significantly different procedures are assigned to a single ICD- 9-CM procedure code. Limitations in the coding system translate directly into limitations in coverage and reimbursement.
Example: CMS has had difficulties identifying and paying for new technology. This has been a particular problem in the cardiovascular and orthopedic parts of ICD-9-CM where many categories have no room for more ICD-9-CM codes. Some of the recent problems have included new devices used in spinal fusions, new cardiac defibrillator devices, and drug eluting stents, among others.
Now that you are ready to begin your journey toward the implementation of ICD-10 there are certain steps you will want to take regardless of what role you play within the healthcare industry. It is important to have basic understanding of what ICD-10 is and how it works.
You should start with the following tasks:
Once you have the basics down you are ready to access your ICD-10 preparedness.
Use the assessments and checklists below to determine your strength and weaknesses. This will help you determine what area’s you need to focus on to prepare for the transition to ICD-10.
This readiness assessment and prioritization tool enables organizations to initiate steps necessary to gather and organize information. Through this exercise of identifying and capturing information about what systems and processes need to be addressed through the ICD-10-CM/PCS, transition management will gain information on what must be addressed and where to apply resources in preparation for the change.
This 100-question biomedical science assessment is designed to assist the coding professional in preparing for ICD-10-CM coding. The purpose of the assessment is to identify strengths and weaknesses in clinical areas.
This 100-question biomedical science assessment is designed to assist the coding professional in preparing for ICD-10-PCS coding. The purpose of the assessment is to identify strengths and weaknesses in clinical areas.
This Questionnaire is designed to gauge your vendors’ readiness for ICD-10 and determine how you will work together to accommodate the transition to ICD-10. The questionnaire can be adjusted to meet the specific needs of your facility.
It's time to start implementing ICD-10. Choose your position in healthcare to get your ICD-10-CM/PCS implementation needs.
You are the resource physician that many offices have who provides advice and guidance to your staff on coding and billing issues.
Group 1 processes related to assigning and/or auditing ICD-10-CM codes including the coding process, processes such as requests for ICD-10-CM codes included with orders for lab and imaging, pharmacy benefits, etc., and regulatory compliance process.
Focus should be on obtaining foundational knowledge of ICD-10-CM and understanding how ICD-10-CM is different from ICD-9-CM.
Group 3 processes require knowledge of ICD-10-CM codes and are not Group 1 or Group 2 processes and functions.
Learn the ICD-10-CM and ICD-10-PCS systems.
Focus on obtaining the foundational knowledge of the biomedical sciences and understanding how ICD-10-CM is different from ICD-9-CM.
Understand the new code sets enough to forecast what you must alter in the database.
Start with ICD-10-CM/PCS planning and training then shift to ICD-10-CM/PCS system conversion.
Go to the implementation model for Health Plans
Ensure that students graduating in the ICD-10-CM/PCS implementation year are prepared to pass their credentialing exam and enter the workforce as qualified ICD-10-CM/PCS coders, analysts and managers.
Ensure you will be prepared to pass credentialing exams and enter the workforce in a coding-related role during the implementation time period and beyond the actual implementation date.
Select an academic program that will successfully prepare you to pass credentialing exams and enter the workforce in a coding-related role during the ICD-10-CM/PCS implementation time period and beyond the actual implementation date.
Evaluate the educational needs of your staff and separate them into two groups: a group that primarily assigns codes and one that primarily does NOT assign codes.
Go to the implementation model for Long-Term Care
ICD-9-CM was developed 30 years ago and it cannot accurately describe diagnoses at the necessary level of detail needed for the management of our healthcare system in the 21st century. In addition, a number of countries have already moved to ICD-10. Therefore, the statistics reported for diagnosis codes will be flawed since there is no compatible data to compare internationally. We will be capturing morbidity data using an outdated classification system, which can potentially cause problems identifying and tracking new health threats (e.g., SARS, anthrax).
No firm timeframes for the completion of ICD-11 developmental work or testing have been identified, and no firm implementation date for ICD-11 has been designated. This means the earliest projected date for ICD-11 implementation would be 2020, assuming that no US clinical modification is needed. Also, since ICD-11 will build upon ICD-10, many of the costs and much of the work associated with upgrading to ICD-11 will be mitigated by ICD-10 implementation.
There are similarities between ICD-10-CM and ICD-9-CM diagnosis codes; however there are also distinct differences. The actual coding process remains the same.
First character is numeric or alpha (E or V)
First character is alpha
Characters 2-5 are numeric
Characters 2-7 are alpha or numeric
Always at least 3 characters
Use of decimal after 3 characters
ICD-10 Superbills: Example 1 Example 2
The increase in the number of codes allows for greater detail and flexibility. Added detail is important in tracking health care trends, analyzing quality issues, and evaluating outcomes for a variety of health care technologies and treatments.
ICD-10-CM/PCS has an improved structure, capacity, and flexibility for capturing advances in technology and medical knowledge. It incorporates greater clinical detail and level of specificity to provide better data for many purposes.
The greater number of codes doesn’t necessarily make it more complex to use, in fact the increase in codes makes it easier to find the right code. The Alphabetic index and electronic coding tools will continue to facilitate proper code selection.
ICD-10-CM was developed and is maintained by National Center for Health Statistics (NCHS) under authorization by the World Health Organization (WHO).
ICD-10-PCS was developed and is maintained by Centers for Medicare and Medicaid Services (CMS).
AHIMA,CMS, AHA and NCHS are the four cooperating parties responsible for the ICD-10 Coding Guidelines.
The following may need some amount of education on the structure, benefits and changes seen in ICD-10-CM/PCS:
As a result of the American Hospital Association/American Health Information Management Association (AHA/AHIMA) ICD-10-CM Field Testing Project, the conclusion was that a maximum of 16 hours of training may be sufficient for experienced coding professionals on ICD-10-CM. Physician practices may not need as much training due to the fact that they may utilize a limited number of codes. It is estimated that the ICD-10- PCS will likely require an additional 16-24 hours of training.
According to the American Hospital Association/American Health Information Management Association (AHA/AHIMA) ICD-10-CM Field Testing Project, the majority of participants believed training should be provided 3-6 months prior to ICD-10-CM implementation as supported by the Field Testing Report.
Click here to participate in the Ambassador Program
The Ambassador Status is valid for 365 days from the date your application is approved, and includes the benefits outlined below:
The Ambassador program is optional and not required for ICD-10 trainer certificate renewal. Participation in the Ambassador program requires that you be an active AHIMA Approved ICD-10 trainer. Your service and efforts are duly noted and appreciated by AHIMA!
AHIMA's Approved ICD-10 Trainer renewal process is based on the Centers for Medicare and Medicaid (CMS) annual updates. Trainers with a certificate which expires June 30, 2013 will need to renew their certificate to maintain their status as an AHIMA-Approved ICD-10 Trainer. The cost to renew one's certificate is $199 if purchased prior to September 1, 2013. After that date, a $50 late fee is applied.
ICD-10-CM Trainer Renewal can be purchased here.
ICD-10-CM/PCS Trainer Renewal can be purchased here.