Given the complexity of issues facing the healthcare industry, it is no surprise that yet another equally momentous matter has not received everyone’s full attention: ICD-10, a new set of diagnosis codes that all U.S. physician practices must use starting on Oct. 1, 2014. Failure to prepare for this looming transition could have serious financial consequences for physicians, hospitals and other organizations.
Beginning Oct. 1, 2014, the U.S. government is mandating the shift from the existing ICD-9 code system to ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) — a coding standard already in use in many other developed countries around the world. The change will expand the number of codes by almost eightfold, from about 20,000 to more than 155,000. The differential between the number of ICD-9 and ICD-10 codes will mean that, in many instances, no “crosswalks” will exist for a one-to- one code match.
The ICD-10 code set expands the field length of the code. The expansion enables the addition of codes to support advances in medicine and to provide greater specificity in clinical documentation. The codes differentiate body parts, surgical approaches and devices used. Injuries are grouped by body part rather than category of injury. Mastering ICD-10 will require that all coders possess in-depth knowledge of anatomy, physiology, medical terms, disease processes, surgical procedures and pharmacology. (See the Appendix for more information on the expanded code set and its origins.)
The good news is that while the ICD-10 transition will be disruptive in the short term, it should have a positive outcome over the longer term. The expansion will benefit the delivery of care by indicating a more precise diagnosis, and more accurately matching the payment for care to the care delivered. In time, this improved precision will promote greater efficiencies in care documentation and claims processing. The greater detail also will provide organizations with improved business intelligence regarding care delivery and operations.
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