How to Prepare for ICD-10 Coding, Software Revisions

Marybeth Regan and Beverly Mann, for HealthLeaders Media, November 4, 2010

The implementation of ICD-10 will transform the practice of medicine itself.

The first major alteration to the International Classification of Diseases in decades is arriving.   Or, more accurately, it arrived in 1994, but only now is it about to arrive in the United States.  By law, on October 1, 2013, the billing and payment system of every healthcare provider and healthcare payer organization  in the United States must use the new ICD-10 codes.  The requirement applies to every provider and payer who is subject to the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

This transformation from the current code to the new one is no small undertaking, but it is necessary if you want to bill and receive payments.  To be prepared, all diagnosis and procedural code systems need to be analyzed and updated, and employees trained. 

Unlike earlier changes in the Code, this one requires thorough and fundamental rewrite for implementation of the software systems used for billing and payment.  These changes are so significant that the government has established a temporary transition format for use during conversion to ICD-10. 

Indeed, because the current version of the Electronic Data Interchange data software, EDI 4010, cannot accommodate the ICD-10 system, the Department of Health and Human Services (HHS) is requiring the providers and payors to upgrade to the new EDI version, 5010, by January 1, 2012.

But the purpose of the change is not merely to upgrade to the latest information technology.  It is to revolutionize the Code itself in a way that will enhance the very practice of medicine, not just improve the efficiency of billing and payment procedures. 

The current Code has approximately 17,000 classifications of medical tests, diagnoses and procedures.  ICD-10, by contrast, has roughly 155,000, enabling—no, requiring—the provider to identify, with precision, the medical care provided, the result, and the expected care, if any, that will follow. 

If used to its full potential, it will serve as a quality-control mechanism, ensuring that the medical care being provided is within the norms for the circumstances.  The effect should be the significant reduction of medical oversights, errors in treatment, and unneeded tests and treatments. 


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