What is ICD-10?
ICD-10 refers to the federally mandated requirement that all HIPPA covered entities convert from ICD-9 codes to ICD-10 diagnostic and procedural codes. ICD-10 (International Classification of Diseases, 10th revision, Clinical Modification) is the U. S. clinical modification to the World Health Organization’s International Classification of Diseases. ICD-10-CM provides many more categories for diseases and other health related conditions. The number of codes available will increase from approximately 14,000 to approximately 69,000 diagnoses codes and from approximately 4,000 to approximately 85,000 procedure codes.1 Most industrialized nations migrated to ICD-10 years ago after it was endorsed by the World Health Assembly in 1990.
According to the Centers for Medicare & Medicaid Services (“CMS”), the ICD codes were last updated 35 years ago and contain many outdated and obsolete terms that are inconsistent with current medical practice. With the conversion to ICD-10 codes, the hope is to improve patient care and public health surveillance, leading to better identification of illnesses and earlier warning signs of epidemics and pandemics. So will October 1, 2015 pass as just another day in the healthcare industry or will chaos ensue? Medicare claims with a date of service on or after October 1, 2015 will be rejected if they do not contain a valid ICD-10 code. Medicare claims processing systems do not have the capability to accept ICD-9 or accept claims that contain both ICD-9 and ICD-10 codes for any dates of service after September 30, 2015, according to a joint release in July 2015 by the CMS and American Medical Association (“AMA”).
The same release also recognized that providers need help with this significant transition, and the CMS adopted policies to allow for flexibility in the claims auditing and quality reporting processes for the twelve months after ICD-10 implementation. The CMS indicated that the final end-to-end testing in July yielded successful results in claims processing and acceptances rates. Other studies and surveys are not as optimistic. An August 2015 study by Porter Research revealed that 85% of the respondents were optimistic they will be ready but 57% of these same respondents also answered they are not on track. Even among those who either will or at least hope to be ready by October 1, more than half anticipate that "negative impacts on their organization's finances, operations and staff morale" will result from the ICD-10 conversion.2 According to Workgroup for Electronic Data Interchange (“WEDI”), considered the nation’s premier nonprofit authority on the use of health IT, their early August study revealed that while the largest providers will be more prepared, the smaller providers and physician groups are more likely to experience cash flow disruptions and to expect uncertainty of cash flows for two years after implementation.
