The ICD-10 Challenge

By Mark Brousseau

“ICD-10 is probably one of the biggest changes to occur in health IT in 30 years,” Dr. Joe Nichols, Edifecs medical director, told attendees at the Medical Banking Project Boot Camp this afternoon at HIMSS10 in Atlanta. “It is massive.”

ICD codes, which were developed for coding institutionally related procedures, are maintained by the World Health Organization (WHO). Most developed countries other than the United States use ICD-10, Nichols noted. The United States still uses ICD-9 codes. The international version of ICD-10 contains approximately 12,400 diagnostic codes. WHO approved the U.S. version of ICD-10, which contains approximately 69,000 codes.

As of October 1, 2013, all claims in the United States must use ICD-10.

Why is this so important? Because ICD-10 is a cornerstone of healthcare information, Nichols said. “It is the standard for defining the health state of the patient, and the institutional procedures that patients may receive to maintain or improve their health state,” he explained. “This is a big change in the coding system.” What was 14,300 codes under ICD-9 will rise to 69,000 codes under ICD-10, Nichols noted, with the number of procedure codes increasing from 3,800 to 72,000 under ICD-10.

With ICD codes pervasive throughout most health systems, and many business functions impacted by the codes, it is important that healthcare organizations have plan for supporting ICD-10 codes.

“ICD-10 codes are used for a lot of things,” Nichols said. As examples, he mentioned: actuarial and financial risk; adjudication; outcomes; population health analysis; benefits design; fraud, waste and abuse analysis; quality and efficiency assessment; medical policies and clinical guidelines; payment rules; clinical history; utilization; and regulatory reporting. “We based a lot of our national policies on this,” Nichols said. “The implications are far-reaching. Imperfect mapping from ICD-9 to ICD-10 will affect processing and analytics in a way that impacts revenue, costs, risk and relationships.”

So how do you deal with this?

“If you haven’t started now, you’re going to be behind the gun,” Nichols said. But organizations need to look at their short-term goals with a long-term vision, to determine what solutions they need today, and whether those solutions will meet future needs. Organizations also need to be aware of ICD-10’s touch points with other initiatives, and the potential downstream impacts of the change. And they should collaborate with business and trading partners as they develop their ICD-10 plans. Finally, organizations should use ICD-10 to try to position themselves for competitive advantage. “There are huge competitive advantages to using ICD-10 better than your competitors,” Nichols explained.