Are you prepared for the ICD-10 transition? The initial implementation deadline for the transition was October 1, 2013; however, in August 2012, the U.S. Department of Health and Human Services (HHS) released a final rule announcing a one-year delay of the implementation of the International Classification of Diseases, 10th Edition (ICD-10) to October 1, 2014.*
Health care providers throughout the nation currently use International Classification of Diseases, Ninth Revision, Clinical Modification, or ICD-9-CM. In 2009, HHS published a regulation requiring its replacement. The American College of Surgeons (ACS) encourages members to become familiar with the new code sets, understand the difference between ICD-9-CM and ICD-10, and prepare for how the change may affect their practices. Health care regulators believe that the transition to ICD-10 will have widespread effects on operational processes across health care.
What is the International Classification of Diseases?
In 2003, the Health Insurance Portability and Accountability Act (HIPAA) identified ICD-9-CM as the standard code set for reporting diagnoses and inpatient procedures. ICD is a diagnostic tool for epidemiology, health management, and clinical purposes. It permits the systematic recoding, analysis, interpretation, and comparison of mortality and morbidity data collected in different countries. It is also used to monitor the incidence and prevalence of diseases and other health problems around the world. Currently, ICD-9-CM includes both diagnosis and procedural codes.
ICD-10 is expected to be an expanded code set, including additional information for ambulatory and managed care and injuries. It also is expected to combine diagnosis and symptom codes to better define certain conditions, increase specificity through greater code length, and provide the ability to specify laterality.
Is ICD-9 obsolete?
The Centers for Medicare & Medicaid Services (CMS) states that ICD-9 is obsolete because there is a belief that the terminology and classifications associated with ICD-9 are outmoded and inconsistent with current clinical practice. In addition, ICD-9 can no longer accommodate new codes that address advances in technology, new diseases, and advances in clinical practice.
Where did ICD-10 originate?
ICD-10 was endorsed by the 43rd World Health Assembly in May 1990 and came into use in World Health Organization member states starting in 1994.
What will ICD-10 identify?
Similar to ICD-9, ICD-10 comprises two categories of code sets. The first is ICD-10 clinical modification (ICD-10-CM), which providers will use in both the inpatient and outpatient setting to report diagnoses.† The second is ICD-10 procedure coding system (ICD-10-PCS), which will be used in procedural coding for hospital inpatient and outpatient services.
How will I identify the difference between ICD-9 and ICD-10?
The difference between the ICD-9 and ICD-10 code sets may not be immediately evident. Table 1 provides an overview of characteristics to become familiar with while transitioning into using ICD-10. Table 2 provides examples of general surgery codes currently in ICD-9-CM and how they are proposed to appear in ICD-10-CM.
Table 1. Detecting ICD-9 and ICD-10 code sets
|3 to 5 characters in length||3 to 7 characters in length|
|Approximately 13,000 codes||Approximately 68,000 current codes|
|First character may be alpha (E or V) or numeric; characters 2–5 are numeric||Character 1 is alpha; characters 2 and 3 are numeric; characters 4–7 are alpha or numeric|
|Limited space for new codes||New codes can be added|
|Limited code detail||Specific code detail|
|No laterality||Includes laterality|
Table 2. Examples of general surgery codes crosswalked from ICD-9 to ICD-10
|ICD-9 Code||Descriptor||ICD-10 Code||Descriptor|
|550.90||Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)||K40.90||Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent|
|574.20||Calculus of gallbladder without mention of cholecystitis, without mention of obstruction||K80.20||Calculus of gallbladder without cholecystitis without obstruction|
|553.21||Incisional hernia||K43.0||Incisional hernia with obstruction, without gangrene|
|K43.1||Incisional hernia with gangrene|
|K43.2||Incisional hernia without obstruction or gangrene|
|V12.72||Personal history of colonic polyps||Z86.010||Personal history of colonic polyps|
|540.9||Acute appendicitis without mention of peritonitis||K35.80||Unspecified acute appendicitis|
|K35.89||Other acute appendicitis|
Will ICD-10 replace Current Procedural Terminology (CPT)‡ coding?
No, the implementation of ICD-10 does not affect CPT coding for outpatient procedures. ICD-10-PCS codes are for hospital inpatient procedures only.
What steps should I take to begin implementation of ICD-10 in my practice?
The implementation of ICD-10 will require coordination of all aspects of your practice. One of the most important first steps in the ICD-10 implementation process is to conduct a practice impact assessment, and CMS advises practices to complete this process. An impact assessment will result in awareness of the areas of the practice that will be most affected by the transition to ICD-10. It includes an analysis of how the practice will accept, process, and translate coded data under the ICD-10 system. The costs of implementation will depend on the size of the practice; the largest expenses are expected to be system upgrades and education.
Consider how ICD-10 will impact the following aspects of your practice:
- Systems and vendor contracts: Ensure vendors can accommodate ICD-10 needs and find out how and when the vendor plans to update existing systems. Review existing and new vendor contracts and evaluate vendor offerings and capabilities against the organization’s expectations§
- Business practices: Once ICD-10 is implemented, determine how the new codes will affect processes for referrals, authorizations/precertifications, patient intake, physician orders, and patient encounters§
- Productivity: Train staff to accommodate the substantial increase and specificity in code sets, physician workflow and patient volume changes, and the amount of time needed for testing§
- Reimbursement structures: Coordinate with payors on contract negotiations and new policies that reflect the expanded code sets§
The transition to ICD-10 will be significant and will affect most areas of a practice and, thus, its impact should not be underestimated. A smooth and successful transition requires proper planning and preparation. The ACS will continue developing resources for Fellows to address the implementation of ICD-10.
Accurate coding is the responsibility of the provider. This article is intended only as a resource to assist in the billing process.
*All specific references to ICD-9 and ICD-10 codes and descriptions are © 2012 World Health Organization.
†Centers for Medicare & Medicaid Services. Official CMS industry resources for the ICD-10 transition. Available at: www.cms.gov/ICD10. Accessed March 5, 2013.
‡All specific references to CPT (Current Procedural Terminology) codes and descriptions are © 2012 American Medical Association. All rights reserved. CPT and CodeManager are registered trademarks of the American Medical Association.
§The Centers for Medicare & Medicaid Services. Steps to assess how the ICD-10 transition will affect your organization. Available at: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ConductinganICD10ImpactAssessment.pdf. Accessed March 5, 2013.