ICD-10 Information

The most widely used diagnostic classification in healthcare is the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD). The ICD is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases that is used internationally to classify morbidity and mortality data for vital health statistics tracking. ICD-9 code set is presently used by the health care industry. This 30-year old code set is no longer clinically accurate with current medical science. The United States is the last industrial nation to adopt the ICD-10 coding. ICD-10 code set is a complete replacement of the ICD-9 to be used in reporting of diagnosis and procedures. Diseases have been reclassified to reflect the advances in medical practice and clinical knowledge. It contains new and updated codes in alphanumeric code format that provide detailed information to be carried and analyzed. The business processes that currently support the ICD-9 code set may not support the changes in the ICD-10 code set.

What options do you have to deal with ICD-10?

The implementation of the ICD-10 within the payer organization will impact almost all areas of a payer's business.

• Current systems are integrated with ICD-9 codes to a great extent and thus cannot handle the expanded character sets of ICD-10
• Transitioning from ICD-9 to ICD-10 codes will not involve a similar level of complexity across all codes
• Compels extensive training on ICD-10 to the staff
• Requires additional staff to handle the data conversion and claim processing errors
• Increased documentation costs
• Unable to process the claims submitted in both ICD-9 and ICD-10 formats
• Processing errors due to inaccurate data will lead to payment delays thus causing penalties; leading to provider/customer dissatisfaction