On October 1, 2015, the US healthcare industry will start the implementation of International Classification of Diseases, 10th Edition (ICD-10), an upgrade from the International Classification of Diseases, 9th Edition (ICD-9) for medical diagnosis and inpatient procedure coding. ICD-10 diagnosis and procedure codes must be used for all healthcare services and hospital inpatient procedures provided in the U.S. Claims with ICD-9 codes for services provided on or after the compliance deadline will no longer be processed.
Why do we need to change to ICD-10?
The United States is the only country in the world that is still using ICD-9. Furthermore, the ICD-9 codes use outdated terminology and lacks specificity. It is also running out of room for additional codes as thousands of new diseases are submitted annually. ICD-10 has 141,000 codes — more than 8 times the 17,000 codes in ICD-9. The additional codes will enable practices to be more specific on claims forms in reporting the care provided to patients.
How will ICD-10 affect the healthcare industry?
ICD-10’s effect will cover every aspect of the US healthcare industry.
Diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accessibility Act (HIPAA) will need to be changed, its current systems upgraded for compliance.
Healthcare providers, payers, clearing houses and billing services must be prepared to comply with the transition to ICD-10.
All electronic transactions must use Version 5010 standards, which has been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes.
How should healthcare companies prepare for the transition?
The transition to ICD-10 is expected to have a huge impact on the healthcare industry and as early as 2012, government agencies have been helping healthcare providers, vendors and payers to prepare for the transition as this will be a major undertaking. They would need to devote time and financial resources to make the transition as easy and as trouble-free as possible.
- It is recommended that healthcare providers look for specialty-specific ICD-10 training offered by societies and professional organizations. For medical coders, training will be integrated into the continuing education units (CEUs) that they must take to maintain their credentials. ICD-10 resources and training materials will be available through CMS, professional associations and societies, software and system vendors. CMS has a dedicated website (www.cms.gov/ICD10) to provide the latest information on training opportunities for healthcare providers.
- Medical coders need to have intensive training no sooner than six to nine months prior to the implementation for coders who will not assign ICD-10-CM/PCS codes until compliance date. Hospital inpatient coders will need to have 50 hours ICD-10-CM/PCS training. Other coders will require 16 hours of ICD-10-CM. They will need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding. Physician practice coders will need to learn ICD-10 diagnosis coding. The American Academy of Professional Coders (AAPC) provides continuous training for coders.
- They would also need to confirm if their suppliers for billing services, clearinghouses and software management are ready to upgrade their systems to be compliant with ICD-10.