5 ICD-10 Challenges Facing Every IT Project Manager

By Elizabeth Weidman, senior analyst, Catch Data systems

On Jan. 16, 2009, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule that mandated adoption of ICD-10 by Oct. 1, 2013. The adoption mandate has since been extended by CMS to Oct. 1, 2014. The shift to ICD-10 is intended to be a significant enhancement in the coding and classification of diagnoses and inpatient hospital procedures. CMS’ recent action will provide healthcare organizations in the United States with the opportunity to adapt the same platform used by many industrialized nations today, including the United Kingdom, France, Australia, Germany, and Canada.

ICD-10 is a clinical diagnostic coding system first implemented by the world Health Organization (wHO) in 1993. It replaces the ICD-9 medical code set which cannot accommodate an expansion of additional codes.

ICD-10-CM medical codes expand the current ICD-9-CM code base from approximately 14,000 diagnosis codes to more than 68,000, and from over 3,000 ICD-9-CM procedure codes to more than 72,000. Code structure has increased in complexity, from predominantly numeric three-to-five-digit ICD-9 codes to mixed alphanumeric ICD-10 codes that can contain up to seven digits. This increase in complexity requires accommodation and in many cases increased automation within medical and billing software.

As of Jan. 1, 2012, all electronic transactions (including claims) must be using Version 5010 standards. Version 4010 claims are no longer accepted. Version 5010 standards accommodate the ICD-10 codes.

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