Q. Is the International Classification of Diseases (ICD) coding system used for purposes above and beyond reimbursement?

A. Yes. Health care organizations and governments throughout the world use the International Classification of Diseases for categorizing and tabulating disease. Applications include monitoring, analysis, planning, resource allocation and reimbursement of health care.

Q. How long has the system been in place?

A. The ICD system has a long history, dating back to 1839. The ICD-9th edition has been in place since 1975.

Q. Is the ICD-10 version new?

A. No. A major restructuring of the ICD system occurred in 1993, creating ICD-10. In 1994 World Health Organization member states began using ICD-10. The United States is one of few countries that has not yet implemented it. In the future, ICD-11 will be built on the ICD-10 foundation. 

Q. When will ICD-10 be implemented in the United States?

A. In January 2009, the Department of Health and Human Services set an implementation date of October 1, 2013. All HIPPA-covered entities are expected to be compliant by this date. 

Q. Why is the ICD-9 system no longer adequate?

A. There is a lack of detail in the ICD-9 system. Third-party payers and the government want more information about disease. Specialty societies desire more detail that currently does not exist within the ICD-9 system. In addition, the ICD-9 system does not allow for growth to include newly discovered disease processes. 

Q. Is the number of code additions and changes significant?

A. Yes. ICD-9-CM (Clinical Modification) contains approximately 16,000 codes and ICD-10-CM contains approximately 70,000 codes. ICD-10-PCS (Procedure Coding System) contains an additional 70,000 codes. The ICD-10-PCS will NOT be used on physician claims. It will only be used on hospital claims for inpatient procedures. 

Q. What are some of the specific differences between ICD-9 and ICD-10?

A. There are several differences that include:
  • Character length—ICD-9 codes are three to five characters and ICD-10 are up to seven characters.
  • Alphanumeric—ICD-10 codes begin with either a letter B-D and F-H or a number 0-9. Letters “O” and “I” are not used in ICD-10. 
Q. Is there a particular change to ICD-10 codes that has increased the number of codes so dramatically?

A. Yes. In ICD-10, there is a feature called “laterality” to indicate right, left and bilateral conditions. So, there are separate codes for “cataract, right eye,” “cataract, left eye” and “cataract, both eyes.”
Cataract Coding in ICD-9 vs. ICD-10
 ICD-9 CM  H366.16 Nuclear Sclerosis
 ICD-10 CM  H25.1 Age-related nuclear cataracts
  H25.10  Age-related nuclear cataract, unspecified eye
  H25.11  Age-related nuclear cataract, right eye
  H25.12  Age-related nuclear cataract, left eye
  H25.13  Age-related nuclear cataract, bilateral

This feature of ICD-10, by itself, is responsible for a substantial amount of the increase in the number of codes.

There are also changes to coding for episodes of care. Different codes describe an initial encounter, subsequent encounter and sequela. 

Q. Will I need to update my computer system to handle ICD-10 codes?

A. Yes. Current practice management systems are set up for a maximum of five characters under version 4010 of the HIPAA standards for electronic transactions; a new standard called version 5010 is needed to accommodate ICD-10. Implementation of this new standard will occur in phases—the first phase is already underway. Payers were expected to be able to process 5010 transactions for testing and transition on January 1, 2011. Phase 2 requires that all covered entities begin using 5010 transactions on January 1, 2012. You should verify with your practice management system vendor that your system is 5010 ready. If not, find out what they are doing to ensure compliance by the end of the year.

Q. Will we continue to need both ICD-9 and ICD-10 codes in our computer after October 13, 2013?

A. Yes. Once implemented, practice management systems will need to access both the 9th and 10th edition of ICD for at least two years. Some payers, such as Workers Compensation, won’t make the switch to ICD-10 immediately. Old coverage and payment policies will need to be converted, and that will take time, too. Accounts receivable on October 1, 2013 will still contain old, unpaid claims and some of those may need work using the 9th edition codes.

Q. Will there be any helpful tools like a crosswalk guide from ICD-9 to ICD-10?

A. Yes. General Equivalence Mapping (GEM) files have been created to crosswalk (as nearly as possible) from ICD-9 to ICD-10 and vice versa. While the concept of readily switching back and forth is appealing and seems to promise an easy path forward, the GEM files are not user friendly and imperfect at best. These files are not a substitute for learning how to use ICD-10.

Will I be able to continue using a route slip or superbill to capture both procedure and ICD-10 codes?

A. Maybe. Some experts suggest creating a master document with your most frequently used diagnostic codes. However, ICD-10 codes are much more detailed, so this will be a difficult task. Physicians, and especially coders, will need to become proficient with using the ICD-10 manuals. As a practical matter, you’ll need another solution, such as an electronic device with an ICD-10 application, and GEM files for good measure. Those with electronic health records should expect that their EHR will contain a comprehensive list of ICD-10 codes, but do not expect that it will provide the detailed instructions contained in the manual for proper code selection.

Q. What should I do now to begin to prepare for ICD-10?

A. Do not postpone preparations because the deadline seems far away. Begin by assessing your current documentation and determining if the level of detail is sufficient for selecting the appropriate ICD-10 code. Do you specify which eye, or do you indicate the level of severity of diseases, like background diabetic retinopathy or glaucoma? Begin changing your documentation detail now, if necessary, and develop a plan for computer upgrades, form revisions and training of physicians and staff. You can monitor the CMS website (cms.gov/ICD10) for continued updates.  

Ms. McCune is vice pres­ident of the Cor­coran Con­sult­ing Group. Con­tact her at DMcCune@corcoranccg.com.