CyPace, Inc.

What is ICD 10?

ICD (International Classifications of Diseases) codes are medical diagnosis and procedure codes used for billing and health insurance reimbursement, automated decision support and government statistical reports on morbidity and mortality.  These codes are not specifically used in the US,  they are used around the world.  The ICD coding system is published by WHO (the World Health Organization, a UN agency) and have been around for a very a long time.  Version 1 was created in 1900, with precursors to the ICD codes existing as early as 1853.

ICD-10 (International Classification of Diseases, Tenth Revision) is the latest revision.  For US healthcare providers, ICD-10 may seem like the next big thing, but the ICD-10 standard was created in 1990. To date there are 153 nations which use all or part of the ICD-10 codes.  In the US, ICD-10 codes are “not currently valid for any purpose or use,” according to the National Center for Health Statistics, a division of the CDC (Center for Disease Control), but the government does use the codes for mortality reporting, according to the American Health Information Management Association.

Unfortunately, the US still uses the old ICD-9 coding system.  The limitations of this outdated system are increasing as new diagnostic and treatment procedures become available, because ICD-9 does not have the ability to add new codes for them.  The same is true for new diagnoses.  ICD-9 is not capable of providing granularity of subclassifications of diagnoses or related problems from socioeconomic or lifestyle issues.  Since one of the main uses of ICD codes is medical billing – health insurance payment transaction, and that transaction is now almost universally done electronically, there is a need for the transaction to be able to use the new HIPAA electronic transaction forms (HIPAA 5010) and the current ICD-9 codes just are not set up to do this.

What does all this mean?

It means that healthcare providers cannot always give the most accurate diagnosis and procedure information. This generates more work on the part of health insurance companies, as claims analysts must review ambiguous codes in billing, and medical reviews must be done case-by-case for tests and treatments that might otherwise be standardized by codes.

It means valid bills may be denied or payments are determined incorrectly because the true value cannot be easily seen from the codes.  This could seriously affect patient care, as inaccurate coding can lead to missing the true diagnosis and potentially the wrong treatment for the patient.

It means that public policy will not have the most accurate information from their research.  And it means that, because the US is behind the 153 other countries in getting up to speed, we do not have the capability of interoperability with them.

A quick comparison of ICD-9 and ICD-10 shows us the differences:

Moving to ICD-10

Fortunately for most US healthcare organizations, the federally mandated implementation date has been pushed back from October 1, 2011 to October 1, 2013.  Simultaneously, the industry is transitioning toward the HIPAA 5010 transaction standard to support electronic transactions.  Combined, these changes will impact every aspect of your organization’s revenue or payment cycle.  By October 2013, the federal government has mandated use of the ICD-9 code set must be replaced by the ICD-10 code set.  Hospitals, and physician practices and health insurance companies need to be gearing up for ICD-10 now, but our research has shown that most have not started the transition or have begun only preliminary planning.

One reason for this lacksadaisical approach is in the way providers view this transition.  It seems that  providers are viewing the change as more minor than it is by treating it as a more extensive version of the yearly diagnosis code updates.  Transitioning from ICD-9 to ICD-10 is a huge project, on par with the work effort which was required for the Y2K transition or migration to an Electronic Medical Record and Billing system.   People affected by this transition include physicians, hospitals, other healthcare providers, and medical billing and health insurance claims staff, all of whom must be extensively trained to use the new coding system.  Technology vendors need to update their medical record, billing, insurance and reporting software technology to simultaneously handle both ICD-9 and ICD-10 codes until transition is complete.  Health insurance policies will also need to be updated to accommodate the newly-recognized diagnosis and procedure codes.

An article published by the Texas Medical Association website, approximates the cost to be $83,000 for a small 3 physician practice and more than $2.7 million at a large, 100-physician practice.

Risks of not meeting the transition deadline

We have identified five key risks of not completing the transition on schedule to include:

1. Delayed or denied payments
2. Missed payments
3. Incorrectly processed insurance claims
4. Potential for fraudulent misuse
5. Adverse impact to patient care

It’s Worth the Effort and Expense

After reviewing the limitations of the current ICD-9 system, we decided to outline some of the differences between ICD-9 and ICD-10. Besides resolving the limitations of ICD-9, the ICD-10 system will:

1. Improved disease management diagnoses
2. More accurate, value-based, payments for new procedures
3. Better quality data reporting
4. Allows for the US to compare data with international data on the spread of disease and treatment outcomes

How can CyPace help?

ICD-10 presents a learning curve, but with adequate process and systems preparation, stakeholders will have enough time to overcome the challenges.  As a trusted source for coding information, CyPace Healthcare can help you navigate through this important change.  Our team of experts provides education, services, and analytics for ICD-10 to help you:

• Understand the conversion process
• Develop migration roadmaps and stragegies
• Assess your EMR or Billing vendor’s readiness
• Analyze systems integration capabilities
• Provide ICD-10 training and education

The transition is going to be challenging, with each procedure record used in your Electronic Medical Record (EMR) or billing system needing to be touched.  The CyPace Healthcare Application Management Platform (CHAMP) is designed to aide in the transition allowing you to find procedures, fee schedules, and diagnosis records containing the old ICD-9 value(s) with simple but powerful reporting.

For more information about CyPace and the CyPace Healthcare Application Management Platform, please visit http://www.cypacehealthcare.com or contact us at (866) 589-0438 x701