A technical switch from ICD-9 to ICD-10, why it matters

Oct 1 marked the day when many healthcare institutions, insurers, CMS (Center for Medicare and Medicaid Services) switched over from International Classification of Diseases 9 (ICD-9) to International Classification of Diseases 10 (ICD-10). Much heralded in some circles (Europe, Asia and Africa implemented ICD-10 decades ago) and sometimes referred to as healthcare’s version of Y2K in others, it has come about with years of delay, angst, optimism and controversy.

The switch to ICD-10 from ICD-9 isn’t just an increase in the number of codes by tens of thousands (17,000->~68,000), it is an upgrade that is long overdue (ICD-10 was created in 1990). The benefits of ICD-10 include:

  • an improvement in clinical documentation- new updated terminology, inclusion of laterality, illness severity
  • better ability to capture the scope of clinical care and outcome indicators
  • more appropriate re-imbursement (electronic record and evidence of care)
  • added value to technology and health reform initiatives as healthcare moves towards coordinated care models and value-based cost-efficient care
  • better ability to conduct public health surveillance

The downsides of ICD-10 are the costs of implementation and that despite delays, some providers and institutions still aren’t prepared for the system upgrade, which can translate into coding errors, re-imbursement dips, delays in procedure or testing authorizations, and even insurance denials for patients. Fortunately enough, CMS has instituted a one year grace period for claims submitted on or after October 1, but only if the codes submitted for a particular diagnosis are classified under the correct family of codes. As for individual payers, they may have their own set of rules when it comes to incorrectly coded claims.

ICD-10 is a stepping stone into ICD-11, set to be released by 2017. Expectations of when the U.S. will adopt ICD-11 are to date, unknown.