Background on ICD-10
ICD-10-CM and ICD-10-PCS Quick Facts
| Definition of ICD: | International Classification of Diseases | |
| History/Purpose: | Originally developed in the late 19th Century as International List of Causes of Death | |
| Evolution: | Became basis for classification of illness and treatment throughout world | |
| Current ICD Usage in the US: | Only industrialized nation using the approximately 30-year-old ICD-9 and CPT-4 (Current Procedural Terminology) | |
| Planned ICD Usage in the US: | ICD-10 Clinical Modification (CM) and Procedural Coding System (PCS) were modified for usage in the US by 3M Corporation under contract to CMS in 1998 | |
| Output Systems: | ICD was not designed or intended for primary documentation of clinical care; input coding systems, such as SNOMED CT, are used for that purpose | |
| Legislative Authority: | HIPAA Transactions and Code Sets Rule, 1996 | |
| Effective Date: | October 1, 2013 | |
| Increased Number of Codes: | From 17,000 to 140,000 | |
| Format and Length Change: | From three to five mostly numeric to five to seven alphanumeric |
Reasons for Transition from ICD-9 to ICD-10
- Improves specificity because of the substantial increase in number of codes
- Enables comparison of data for clinical, research, and payment purposes
- Enables creation of new diagnosis and procedure codes from advances in medicine and technology
- Enables a high degree of automated claims adjudication and more accurate payments
Impact of the Transition from ICD-9 to ICD-10
- Affects both providers of care and payer organizations
- Requires process reengineering - creation or modification of "Input" and "Code-Driven" or "Code-Dependent" clinical and business processes
- Requires replacement, remediation, upgrading, or outsourcing of legacy information systems
Scope of the Transition Effort
- Compliance is required for claim submission and payment to/from all payers
- Compliance is required for pay-for-performance and DRGs
- There is a lack of long-term "workarounds" - cannot map/translate from ICD-9 to ICD-10
- Healthcare organizations must comply with 5010 electronic transaction sets as a prerequisite to ICD-10
- Compliance optimizes the use of electronic medical record (EMR) with auto-coding
- Experience shows three to four years is required to achieve compliance
- Experience in other countries showed an initial doubling of days in accounts receivable for provider organizations
- Experience in other countries showed an initial fifty percent reduction in coder productivity
- Because of the implementation of ICD-10-PCS, the US implementation effort will be far more complex than it was for other countries