The recent switch to the International Classification of Diseases, Tenth Edition (ICD-10) from ICD-9 on October 1, 2015, in the United States has been beneficial yet challenging. ICD-10 is a medical cataloging system created by the World Health Organization broken down into two systems: ICD-10-CM (Clinical Modification), for diagnostic coding; and ICD-10-PCS (Procedure Coding System), for inpatient hospital procedure coding. More specifically, the CM system documents diagnosis and health statuses, while the PCS system documents root operations, procedures, and interventions.
Why the Switch?
Although ICD-9 has been used in the United States since 1979, this system no longer reflects the modern practice of medicine that has emerged within the past 30 years. There have been many advancements in medical technology post ICD-9 implementation, such as computed tomography scans and other advanced imaging platforms. With the transition to ICD-10, professionals in the health care industry, such as providers, coders, IT professionals, insurance carriers, and government agencies, are afforded many more classification options that were not prevalent in its predecessor ICD-9. In an era of rapid technological advancements, ICD-10 also allows for a smoother transition to eHealth—the electronic transfer of health resources and health care. The use of information and communication technologies offers the opportunity to improve the way in which physicians practice medicine, by driving value-based quality, fostering collaboration, improving the health of populations served, and strengthening the doctor-patient relationship.
Benefits of the Shift
The benefits of the shift to ICD-10 can be categorized into four categories: clinical, operational, professional, and financial.
- Clinical: Due to more diagnosis codes being generated with ICD-10 (68,000 codes of three to seven characters) than with ICD-9 (14,000 codes of three to five numeric digits), diagnosis of patient conditions has become much more specific. This allows for better data collection, documentation, and evaluation and ultimately better clinical decisions. Be mindful that a change in diagnosis codes applies to both medical doctors and doctors of osteopathy who practice osteopathic manipulative treatment.
- Operational: The United States is the last industrialized country to adopt the ICD-10 language into its health care system. This adoption allows for all providers inside and outside the United States to speak the same language.
- Professional: Improved specificity of data leads to higher quality and more efficient reporting of patient conditions.
- Financial: Having better documentation of patient complexity and level of care leads to fewer claim errors, reduced opportunities for fraud, and better rationalization of medical necessity.
Challenges Moving Forward
Now that the biggest challenge of rolling out ICD-10 has been completed after years of delay, it is time to look at some key challenges that this useful yet complicated system may provide. First of all, users of ICD-10 must go through a training program, so the biggest challenge will be patience while learning the new system and keeping up with the changes that may come along the way. Next, users will have to make sure that they remember to use the ICD-10 codes instead of ICD-9 codes. Just as it takes some time to get used writing the proper year at the start of a new calendar year, it is vital for users to keep reminding themselves the correct format and what each code represents for ICD-10. Even when the correct format is used, there will be an increase in denials, which is common when implementing a new system, as many codes may be unspecified. Last but not least, a drop in productivity is inevitable, as coders will try to decipher physician notes, creating a backlog in coding, billing, and payment of claims.
The transition to ICD-10 will not be an easy one, but it will have a significant positive impact on the U.S. health care industry once providers become more accustomed to using this system. As Cardiologist Mark Bieniarz states, “ICD-10 allows us to speak the same language as the people that are going to be telling our story—for outcomes, for data assessment, and for billing. It’s incredibly important to have the severity of the disease we are managing absolutely portrayed.”
Are you up to the challenge?