The medical community was expected to be making the switch from ICD-9 to ICD-10 later this year, however on July 31, 2014, the U.S. Department of Health and Human Services ("HHS") issued a rule finalizing October 1, 2015 as the new compliance date. [1]
“ICD” stands for the “International Classification of Diseases”, and ICD-10 is the tenth revision to this system. [2] There are significant differences between the two coding systems, mostly due to the increased number of codes for ICD-10. [3] The medical community has had mixed reactions to the change, though the reaction has been mostly positive. [4]
The ICD system is a medical classification list from the World Health Organization (“WHO”). [5] The system is used to classify diseases and other health problems recorded on health and other vital records, including death records, as well as billing. [6] Since the ICD system is used for billing, on October 1, 2015, ICD-9 codes will no longer be accepted for reimbursements. [7] This conversion is required by the Health Insurance Portability and Accountability Act (“HIPAA”). [8] ICD-10 uses a three to seven digit code to classify diseases and other health information. [9] The first three characters are used for the category of disease or injury. [10] For example, S52 refers to the fracture of the forearm. [11] The fourth through sixth digit refer to etiology, anatomic site, severity, and other clinical details. [12] For example, S52.51 refers to a torus fracture at the lower end of the right radius. [13] The final character is used for an extension, or additional information that has not yet been discovered. [14]
Since ICD-9 has been in use for over thirty years, it has become very outdated and difficult to use. [15] The revisions to ICD-10 were meant to address these issues. [16] ICD-9 lacked specificity in the amount of information conveyed. [17] The ICD-10 is able to distinguish between the right and left side of the body, as well as an initial or subsequent encounter and other clinical information. [18] Some of the chapters in ICD-9, which break down the codes to make them easier to find, have become full and it is difficult to add new codes or keep related codes in the same chapters. [19] ICD-10 has over five times as many diagnostic codes and approximately twenty-nine times as many procedural codes, allowing for more specificity and flexibility with the evolution of information. [20] ICD-10 expands on the use of combination codes as well. [21] Combination codes are a single code used to classify two diagnoses or a diagnosis with an associated secondary process or complication. [22] With ICD-9, two separate codes were used, such as 707.06 for a pressure ulcer in the ankle and 707.21 for a stage I pressure ulcer. [23] Under ICD-10, the code can be reduced to L89.501 for a pressure ulcer of an unspecified ankle, stage I. [24] Finally, ICD-10 allows for more defined procedures. [25] For example, under ICD-10, physicians can use the code 0DN90ZZ for a release of the duodenum, open approach. [26] Under ICD-9 this would simply be coded as 39.50 for an angioplasty. [27]
The medical community’s reception to the transition has been both positive and negative. ICD-10 does allow for coding to keep up with the changing data due to the increased number of codes available. [28] This transition will also bring the United States up to date with the rest of the world. [29] Currently, the United States is the only country still using ICD-9, excluding those who are underdeveloped and do not use a coding system. [30] This transition will allow the United States to better communicate with the rest of the world in the medical field. Finally, ICD-10 will allow for better tracking of public health risks, quality data, and the ability to design payment systems. [31] Some, however, do not see this transition as positively. Currently, a great deal of clinical documentation is not specific enough for the new codes and will have to be reworked. [32] This will amount to a lot of preparation for physicians to be ready for the October 1 changeover date. Payers are also not going to accept ICD-9 codes past the October 1 deadline. [33] This means that many physicians will have to keep cash in escrow to allow for delays in payments resulting from the late switches. [34] Further, most payers will not reimburse for unspecified codes. [35] Unspecified codes are commonly used when doctors do not know exactly how to diagnose a patient. [36] Many, however, see the potential in this change despite the difficulties. [37]
References:
ICD-10, Centers of Medicare & Medicaid Services, http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10; The Differences Between ICD-9 and ICD-10 Fact Sheet, American Medical Association, http://www.ama-assn.org/ama1/pub/upload/mm/399/icd10-icd9-differences-fact-sheet.pdf [hereinafter Fact Sheet].
International Classification of Diseases (ICD), World Health Organization, http://www.who.int/classifications/icd/en/ (last visited March 5, 2014).
Fact Sheet, supra.
J.A. Johnson, What’s The Buzz About ICD-10, Guardian Liberty Voice, (Feb. 27, 2014), http://guardianlv.com/2014/02/whats-the-buzz-about-icd-10/.
International Classification of Diseases, supra.
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ICD-10 Code Set to Replace ICD-9, American Medical Association, http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-code-set.page, [hereinafter ICD-10 Replacement] (See ICD-9 and ICD-10 Code Freeze).
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Fact Sheet, supra.
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ICD-10 Replacement, supra.
Compliance Date, supra.
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Johnson, supra.
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David Pittman, Docs’ Charting Falls Short of ICD-10 Demands, Medpage Today, (April 12, 2013), http://www.medpagetoday.com/MeetingCoverage/ACP/38432.
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Johnson, supra.