ICD-10 is the 10th edition of The International Statistical Classification of Diseases and Related Health Problems; published by the World Health Organization (WHO), ICD-10 codes are, “a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases”. In a March, 2014, bill providing a short-term “SGR fix,” the implementation date for ICD-10 was delayed to at least October 1, 2015. All HIPAA “covered entities” must make the change to ICD-10 coding by then. In other words, ICD-9 codes will no longer be accepted, and ICD-10-CM codes must be used after October 1, 2015. As usual, the normal coding rules for inpatient treatment will apply; meaning, the ICD code(s) employed will be based on the date of discharge, not the date of admission.
The development of, and transition from ICD-9 to ICD-10 has taken nearly two decades, but the procedure and diagnosis codes used by healthcare providers on a daily basis have been elaborated and specified. ICD-10 includes updated and expanded classification of diseases and medical terminology. The ICD-10 codes are more detailed and specific, more clinically accurate, and more logically organized.
What Was Wrong With ICD-9? – Why the change to ICD-10?
Simply put, ICD-9 is out of date. Everything in the world has changed over the past twenty years, none more so than healthcare and technology. The ICD-9 to ICD-10 transition is meant to update diagnosis coding and better combine the advances in healthcare and technology. The current ICD-9 coding system has limited capacity, and will be unable to accommodate the future advances in healthcare and technology. ICD-10 codes are meant to better reflect current medical diagnoses, practices, techniques, and technology. With the diagnosis coding transition, 13,000 ICD-9 codes will be expanded to 68,000 ICD-10-CM codes, allowing healthcare providers to better define a patient’s diagnosis, especially in conjunction with electronic health records (EHRs). The expanded data collection of ICD-10 will allow healthcare providers to:
- Improve quality measurement
- Reduce errors in diagnosis coding
- Improve analysis of disease patterns
- Better identify instances of abuse and fraud
- Improve tracking and response to public health issues and outbreaks
- Incorporate greater specificity and clinical information
- Expand the detail relevant to ambulatory and managed care encounters
- Decrease the need to include supporting documentation with claims
- Increase sensitivity for grouping and reimbursement methodologies
- Improve the efficiency of claim submissions, especially with EHR and Practice Management Software
Essentially, ICD-9 is unable to provide the necessary detail for patients’ medical conditions or the procedures and services performed as required by healthcare providers in the 21st century. At 30 years old, ICD-9 is simply outdated and obsolete diagnosis coding; it can produce limited and inaccurate data, and cannot accurately describe the diagnoses and procedures associated with medicine today. ICD-10 brings diagnosis coding up to speed with modern medicine and technology.