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. The US is the only industrialized nation not using an ICD-10-based classification system.
ICD-10 matters to all healthcare professionals because coding touches many aspects of healthcare including, data management and reporting, billing and reimbursement, quality reporting, risk management, etc. All healthcare professionals should have a baseline knowledge of ICD-10.
There are two main reasons that the transition to ICD-10-CM/PCS is 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 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 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.
This planning and preparation checklist, organized in phases, was prepared to guide healthcare organizations in effectively planning and managing the ICD-10 transition. This is intended to be a general guide, not a comprehensive project plan. This resource has been developed to assist all types of facilities in the implementation of ICD-10-CM/PCS.
Choose your position in healthcare to get your ICD-10-CM/PCS implementation needs.
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.
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.
Recommended Training: 1/2-3 hours
DETAILS AND PURCHASE
Webinar - ICD-10-CM and ICD-10-PCS: A Major Change for U.S. Healthcare (Web Replay or Audio CD)
Webinar - From Point A to ICD: Successfully Implementing ICD-10-CM/PCS (Web Replay)
Webinar - ICD-10 Prep: Assessing Coders' A&P Proficiency (Audio CD)
Recommended Training: 4 hours
Webinar - How ICD-10-CM/PCS Impacts Your CDI Program (Audio CD)
Webinar - Introduction to Coding Systems for Non-coders (Web Replay or Audio CD)
Webinar - ICD-10 Implementation Tools (Web Replay or Audio CD)