ICD-10 Implementation

We have discussed at length many of the changes to healthcare practice and policy that are currently being proposed or implemented. Most of these are driven by new advantages in technology that allows us to take advantage of new technologies to improve the way we treat and interact with patients.

Currently ICD-9 (International Statistical Classifications of Diseases) codes are in place to report medical diagnoses and inpatient procedures.  Several chapters in ICD-9 are full and new codes can not be added. The practice of medicine has changed dramatically in the last couple of decades. The years since ICD-9 was implemented in 1977 have seen new conditions and diseases discovered, new treatments developed, and dramatic changes in medical devices and resource roll outs. As a result, new problems, conditions, and updates and expansions of known medical issues cannot be separated as we discover new medical knowledge. This severely limits billing and treatment options.  ICD-9 can not keep up with all these advances and changes in the system are inevitable. ICD-10 is rolling out and will replace ICD-9 on October 1, 2013, the compliance date is October 1, 2014.

What is the difference between ICD-9 and ICD-10? ICD-10 provides more  specific and in-depth diagnosis codes and procedures. The new set of codes will describe precisely what procedure was done to the patient, what body part, what method and what medical device was used. The format and structure of the ICD-10 codes varies greatly from the previous diagnosis codes.

ICD-9 codes are 3-5 characters in length and the first digit may be alpha (E or V) or numeric. While ICD-10 are 3-7 characters in length and digit 1 is alpha,  digits 2 and 3 are numeric, digits 4-7 are alpha or numeric. This means that ICD-9 was limited to 17,000 diagnoses, whereas ICD-10 allows billing for over 140,000 distinct diagnoses and procedures, based on statistics provided by the U.S. Department of Health and Human Services:.

Information Technology and software will see the biggest impact on the transition. Healthcare billing departments will also have a large impact and further training will need to be done during the transition to ICD-10. Patients will not see an impact.

This sounds too complicated. Do I have to upgrade to ICD-10? Yes, this is mandatory. If you do not upgrade, you can not bill charges. The transition is required by everyone covered under HIPAA.

Why? ICD-10 exists to move your coding and billing practices forward in the 21st century. As comfortable as you may be with ICD-9, those codes are more than 30 years old, and are missing critical information, such as accurate anatomical descriptions, and differentiation of risk and severity among several issues.

How can I go about this change?  While understanding the structure of a basic ICD-10 code is important, a great deal of the change is understanding how to bill more for more complex conditions, as well as to allow payers and providers to keep better track of what they are paying and billing for. You may be concerned about the difficulty of switching to ICD-10. But it doesn’t have to be as hard as you think it might be.

Most new EHR systems have already begun the transition, and when diagnosing a patient using Certified EHR Technology, you will be able to see medical conditions and problems that are new to ICD-10, as well as the ICD-10 codes that match to old ICD-9 conditions. You should be able to use these comparisons to quickly learn the changes, and with the help of a powerful EHR and a good support team to help you implement change, learning ICD-10 should be incredibly easy, likely much simpler than learning ICD-9 was.

There are several resources for implementing ICD-10 on the internet. The American Medical Association has published a checklist online. This is a good start for implementing ICD-10 in your practice!

Further Readings:

Centers for Medicare and Medicaid Services ICD-10 Factsheet

ICD-10 Implementation Guide for Small and Medium Practices

American Health Informatic Management Association: ICD-10 Implementation Basics


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