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ICD-10 FREQUENTLY ASKED QUESTIONS

What is ICD 10?
In Brief:    
The International Classification of Diseases (ICD) in its 9th revision must be replaced by the 10th revision for coding diseases and procedures by all payers, providers and third parties in the U.S. by October 2014 according to federal law.  It is the largest and most complex revision to the ICD coding system ever.

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ICD-10 or the International Classification of Diseases, Tenth Revision, consists of two new units:  clinical modification (ICD-10 CM) for diseases and procedural coding system (ICD-10 PCS) that will replace ICD9 that is currently being used in the United States. The ICD-10 are code sets which provide for expanded detail for inpatient, ambulatory and managed care to better define certain conditions, increased specificity through greater code length and ability to specify laterality (left-right, front- back).  The requirement to commence using the ICD-10 coding system in the United States is based in the statute for HIPAA. Development and maintenance of the US version of ICD-10 is accomplished by the Centers for Medicare and Medicaid (CMS).
What is different about ICD 10 from ICD 9?
In Brief:
There are a significant number of structural differences between ICD-9 and ICD-10.  The two with enormous implications for providers are the need for more space in computer systems to hold as many as 7 characters versus 5 characters; and the substantial increase in codes.

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The most important attributes of the disease codes are the following:
  • ICD-9 uses code of 3-5 characters in length, while ICD-10 uses code of 3-7 characters in length
  • ICD-9  consists of approximately 13,000 codes, while ICD-10 will contain 68,000 codes
  • ICD-9 has limited  space for adding new codes, while ICD-10 is highly flexible for adding new codes  identify disease etiology, anatomic site and severity of condition
  • ICD-9 lacks laterality, while ICD-10 uses laterality identifying right & left
  • ICD-10 diagnosis codes provide enhanced specificity to identify disease etiology, anatomic site and severity of condition
The profound difference in ICD-9 to ICD-10 occurs in procedural coding sets:
  • ICD-9 uses codes of 304 numbers in length, while ICD-10 uses 7 alpha numeric characters
  • ICD-9 contains approximately 3000 codes, while ICD-10 provides for 87,000 available codes
  • ICD-9 lacks laterality, while ICD-10 provides for laterality
  • ICD-9 uses generic terms for body parts, while ICD-10 uses detailed descriptions for body parts
  • ICD-10 provides for precisely defining each procedure with detail for body part, approach, any device used and qualifying information.
  • ICD-9 uses codes of 304 numbers in length, while ICD-10 uses 7 alpha numeric characters
  • ICD-9 contains approximately 3000 codes, while ICD-10 provides for 87,000 available codes
  • ICD-9 lacks laterality, while ICD-10 provides for laterality
  • ICD-9 uses generic terms for body parts, while ICD-10 uses detailed descriptions for body parts
  • ICD-10 provides for precisely defining each procedure with detail for body part, approach, any device used and qualifying information.
What do I need to know about ICD 10 transitions?
In Brief:
If you are an entity covered by HIPAA and dealing with patient care claims, you must make the change to ICD-10.  For hospitals paid by Diagnosis-Related Groups (DRGs) the change could have financial implications in terms of what you are paid by public and private payers.

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The transition to ICD-10 coding systems in the United States is not voluntary, but is required by federal statute for all providers, payers and third parties who process patient care claims covered under HIPAA. The only exclusions are for claims associated with worker’s compensation, property and casualty insurance programs. It has been stated that the conversion to ICD-10 will impact every information system used in US healthcare system with the possible exception of dietary operations and parking, given that all others have coding content embedded in their processing computer coding.

At present we anticipate that all providers and payers will be required to make a complete one-time transition to using ICD-10 coding systems for all patient activities as of October 1, 2014.
How do I know how ICD 10 is going to affect my institution?
In Brief:
You do not know the impact, unless you have done a complete assessment, and you do not know the financial impact for hospitals, unless you have done a financial impact analysis.

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Each provider and payer needs to carry out a detailed internal assessment, as well as an assessment of all vendor software programs for all operating, reporting and information systems, to determine the degree to which the internal structure contains ICD9 coding currently.  Once the base system wide assessments are completed, the providers and payers will elect to conduct a simulation that converts a large sample of their current claims coding content to ICD-10 coding content so that an impact analysis can be completed.  This analysis will highlight the impact on service lines and margins for those service lines.   The federal mandate to convert to ICD-10 requires that the national impact be revenue neutral in aggregate, but any single institution may experience significant variances in margins for their service lines by payer.
Who needs to understand ICD 10 coding in the hospital setting?
In Brief:
Finance and health information technology personnel.

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The most obvious entities within a hospital that will need to understand the impact of the conversion to ICD-10 are finance, revenue cycle management, health information management departments and the attending physicians.  Yet, the reality is that the conversion of ICD-10 will have impacts on every hospital department given that this is a new language and coding system that will alter every patient care and reporting system used within the organization that uses these codes.
What tools are available?
In Brief:
There are many aspects of the conversion with tools for the issues raised.  Our customers have found that an initial assessment of the probable financial impact is a good place to begin in order to get attention from leadership about the implications of ICD-10.

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There are many tools that have been developed to facilitate and validate the transition for ICD-9 to ICD-10 including:
  • Computer assisted tools to read every current hospital information code system to identify and document every instance where an ICD-10 code is currently used within the embedded code.
  • Computer assisted tools to mitigate or convert a portion of the existing ICD-9 code content into ICD-10 code. 
  • Analytic tools such as GEMs, General Equivalency Methods-- to simulate the conversion of existing ICD-9 codes to the most probable ICD-10 equivalent.
  • Analytic tools used to assess the probable financial implications of the coding system conversions.
  • Project management tools to document and manage the immense data flow associated with the efficient and accurate conversion of existing computer coding content from ICD-9 to ICD-10.
  • New tools are in development to conduction validation audits where the user can confirm that the actual coding conversions have been successfully implemented.
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