ICD-10 is the World Health Organization’s code classification system currently used by healthcare organizations most industrialized nations, excluding the United States. Currently, the United States uses the ICD-9 coding system, which is over 30 years old. All HIPAA-covered entities are required to move to ICD-10 code sets by October 1, 2014. All healthcare services and discharges on or after October 1, 2014 must be coded using the ICD-10 code set, and ICD-9 coded transactions will be rejected.  The transition to ICD-10 will require extensive system and workflow changes within hospitals, payers and other covered organizations.

The coding system includes ICD-10-C, which classifies more than 68,000 diagnoses.The new codes provide for the level of detail needed for morbidity classification and diagnostics specificity in the United States. ICD-10-C also provides code titles and language that compliment accepted clinical practice in the US.

The system also includes ICD-10-PCS, which classifies more than 87,000 healthcare procedures, and is far more detailed and specific than ICD-9-CM.

The ICD-10 code set supports comprehensive reporting of higher quality data, reflecting modern advances in medicine, including current medical terminology. The ICD-10 code set is also more flexible for expansion and including new technologies and diagnoses.

According to the Centers for Medicare and Medicaid Services (CMS), moving to the greater detail and specificity in ICD-10 will:

  • enable better clinical decision making, once integrated into providers’ EHR’s and EMR’s
  • provide better business intelligence and performance improvement data sets and processes
  • improve billing, reimbursement and revenue cycle processes
  • support value-based purchasing by more accurately defining services and diagnoses
  • further Medicare’s ability to detect and prevent program abuse
  • ensure more accurate payments for new procedures and fewer rejected claims,
  • improve disease management, including worldwide disease monitoring and reporting_____________________________________________
    Read more about the scope of ICD-10 implementation, and how we can help you manage your ICD-10 project.