The role of ICD-10 codes in health IT

The role of ICD-10 codes in health IT

When the U.S. government finally sets a deadline for making the move to ICD-10 codes, no health care organization wants to be caught without an ICD-10 implementation plan. This guide will help you get there.

The International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10) is the latest iteration of the code set developed and approved by the World Health Organization (WHO). It is widely used in the developed world for recording morbidity and clinical data. The United States, on the other hand, continues to use a version of ICD-9 for clinical and billing purposes. ICD-9 dates back to 1979 and, as a result, is almost universally regarded as inadequate for coding 21st century medicine. The American Medical Association and its vociferous opposition to ICD-10 is a notable exception.

The U.S. Department of Health and Human Service's mandated switch to ICD-10 codes, originally slated for Oct. 1, 2011 and later pushed back two years, was delayed again in February 2012. A new deadline has not been announced, though a delay is expected to be in yearlong increments (as opposed to, say, six months) in order to remain consistent with the start of the federal fiscal year.

While burdensome health IT mandates such as meaningful use, quality reporting and health information exchange -- not to mention politics -- have motivated the ICD-10 delay, the primary cause has arguably been the inability of health care organizations of all sizes to create and execute a viable ICD-10 implementation plan.

The transition to ICD-10 codes does not require new hardware or software per se but, rather, a comprehensive examination of which clinical and administrative processes, and their requisite IT systems, are affected by the new code set. Accordingly, the timeline for a proper ICD-10 implementation plan is measured in years, not months.

Simply put, many health care organizations have fallen behind -- and, without an ICD-10 implementation plan, they may not catch up. The stakes are high, as flexibility will not be built into the ICD-10 deadline. Once it has passed, all electronic transactions must use ICD-10 codes, and HHS will no longer accept ICD-9 codes.

Failure to comply will result in delayed claims and, critically, payments. Some have suggested that this may cost large hospitals millions of dollars and may force small practices to close their doors for good. Such sobering news should be enough for any organization to take its ICD-10 implementation plan seriously.

Table of contents:

Getting started: A primer on the transition to ICD-10 codes

ICD-10 implementation is falling behind largely because health care organizations are busy addressing other government mandates. But the effect that ICD-10 codes will have on clinical, administrative and billing are just as major as the meaningful use of electronic health record (EHR) technology. View our frequently asked questions and news stories for insight into how ICD-10 implementation and coding will affect the workflows and technologies used in health care. In addition, learn why the ICD-10 delay should not change an organization's course of action.

Diving in: A five-part series on ICD-10 implementation in the U.S. health care industry

Our five-part series offers a comprehensive look into what is needed for a complete transition to ICD-10 codes, from internal planning and preparation to working with vendors to analyzing the financial impact. These steps apply to providers regardless of their progress with ICD-10 implementation thus far.

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Staying afloat: The latest on ICD-10 coding from AHIMA 2011 conference

Features Writer Don Fluckinger was in Salt Lake City for the American Health Information Managers Association (AHIMA) 2011 conference and exhibition. Here's the ICD-10 news from the floor at the AHIMA 2011 conference.

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Keeping abreast: Industry definitions for ICD-10

These definitions will help health IT leaders understand the different types of ICD-10 the United States will be using and how they differ from the outdated ICD-9 codes currently in use. Also included is some information about ICD-11, which WHO hopes to finalize in 2015.