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 and why it is important, 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.
ICD-10 matters to the coding professional
because accurate code assignment is a coder’s responsibility. Coding professionals must have in-depth knowledge of ICD-10, including applying the Official Coding Guidelines and Conventions.
There are two main reasons that the transition to ICD-10-CM/PCS was necessary:
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 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.
It's time to start implementing ICD-10. Choose your position in healthcare to get your ICD-10-CM/PCS implementation needs.
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.
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.
For over 85 years, AHIMA has been the pioneer in establishing the criteria for quality health information management (HIM) training and education for all types of healthcare professionals. As one of the four cooperating parties responsible for maintenance and guidance of ICD-10 national coding policy, AHIMA best understands ICD-10 coding and documentation and the optimized training methods for learning and retention. Scalable training ranges from online to in-person and include courses, webinars, readiness and proficiency assessments.
AHIMA's training for the acute care setting consists of four stages:
AHIMA's training for specialty settings consists of three stages:
Experience a dynamic training program that teaches proficiency in the ICD-10-CM coding system and prepare to train other coding professionals in this system. Please note that stand-alone ICD-10-PCS programs are not offered separately. Students interested in learning diagnosis and procedure coding should register for ICD-10-CM/PCS: Building Expert Trainers in Diagnosis and Procedure Coding.
The AHIMA Academy for ICD-10-CM begins with a self-paced online course (completion is required prior to in-person training), and continues with two days of in-person training. The online course provides basic training in the ICD-10-CM code sets, and is conducted on AHIMA’s remote Web-based Distance Education Campus. At the in-person workshop, trainers focus on in-class intermediate and advanced ICD-10-CM coding exercises while modeling training techniques. After successful completion of both the online and in-person training portions, attendees may complete an assessment in order to earn an AHIMA ICD-10-CM Trainer Certificate.
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Experience a dynamic training program that teaches proficiency in the ICD-10-CM and ICD-10-PCS coding systems and prepare to train other coding professionals in these systems. Students interested in learning ICD-10 diagnosis and procedure coding should register for this program. Students who wish to learn ICD-10-CM diagnosis coding only should register for the AHIMA Academy for ICD-10-CM: Building Expert Trainers in Diagnosis Coding.
The AHIMA Academy for ICD-10-CM/PCS begins with two self-paced online courses (these must be completed prior to in-person training), and continues with a three-day, in-person workshop. The two online courses provide basic training in ICD-10-CM and ICD-10-PCS code sets, and are conducted on AHIMA’s remote, web-based Distance Education Campus. At the in-person workshop, trainers focus on in-class coding exercises while modeling training techniques. The first day focuses on ICD-10-CM, while days two and three focus on ICD-10-PCS coding. After successful completion of both the online and in-person training portions, attendees may complete an assessment in order to earn an AHIMA ICD-10-CM/PCS Trainer Certificate.
AHIMA’s onsite workforce training allows organizations to train for ICD-10 CM/PCS at their own location. AHIMA subject matter experts will train HIM and other staff members for either CM or CM/PCS during a time that best suites the training needs of the organization. Organizations with a large number of staff can easily train by rotation allowing the continued day to day business to remain uninterrupted. Requests for onsite workforce training can be made here.