ICD-10 — the 10th version of the World Health Organization's medical classification system — will be used to code healthcare claims in the U.S. beginning Oct. 1, 2015. Here are 15 things to know about ICD-10.
1. ICD is short for International Classification of Diseases, or International Statistical Classification of Diseases and Related Health Problems, and was first published by the International Statistical Institute in 1893.
2. WHO took over ICD when it was founded in 1948. It is a global standard for countries to report mortality and morbidity data and it is increasingly used to define and study diseases, monitor outcomes and allocate resources in the clinical setting, according to WHO.
3. ICD-10 was endorsed by WHO in May 1990 and was first used in 1994 by the Czech Republic, Denmark, Romania, Slovakia and Thailand, making it the first coding system to be used since the widespread adoption of computers, according to AHIMA. It is now used by 117 countries around the world.
4. ICD-10 has been used for mortality coding and classification for death certificates since 1999 in the U.S., according to the CDC. However, the U.S. has developed a clinical modification of ICD-10 for medical diagnoses and a procedure coding system for inpatient procedures. ICD-10 includes updates and expansions that allow users to code ambulatory care conditions and additional factors. With 69,823 codes, ICD-10-CM has almost five times as many diagnosis codes as ICD-9-CM, many of which are much more specific.
5. Some of the new ICD-10 codes have been the brunt of jokes, including the comically specific "Struck by orca, initial encounter," and "Unspecified balloon accident injuring occupant, sequela."
6. ICD-10 has been delayed three times — in 2009, 2012 and 2014. In March 2014, Congress passed the Protecting Access to Medicare Act of 2014, which put off SGR cuts and linked the reimbursement delay to the ICD-10 transition, which had been scheduled for Oct. 1, 2014.
7. Many remain concerned that transitions may not be smooth for the October 2015 deadline, saying this could be incredibly detrimental to small physician practices. Some lawmakers, such as Sen. James Lankford (R-Okla.) and Sen. Bill Cassidy (R-La.), MD, are even calling for another delay.
8. On the flipside, others in the industry believe implementation is overdue because it may help healthcare providers better respond to national health threats like Ebola, better monitor diseases and the severity of diseases, and improve patient safety and care.
9. To soften the blow of the looming deadline, legislation was introduced that, if passed, would grant physicians a two-year grace period, shielding them from penalizations during the implementation of the ICD-10 system.
10. However, according to the Coalition for ICD-10, the new coding system will neither be burdensome for physicians nor will it impact the amount physicians are paid.
11. In July, CMS announced changes to help ease the transition to ICD-10 including the following: A one-year transition period for providers to familiarize themselves with the diagnoses codes, lifted penalties for the Physician Quality Reporting System, advanced physician payments if contractors have ICD-10 related issues processing claims, and a new CMS communication center to help monitor and resolve issues.
12. The estimated average cost of ICD-10 implementation for small physician practices is approximately $8,167 but can reach tens of thousands of dollars, according to The Professional Association of Health Care Office Management. Previous estimates in 2014 ranged between $56,639 and $226,105. PAHCOM said the large disparity in estimates is due to new educational and training materials now available that will help providers lower implementation costs.
13. Surveys have found providers may still not meet the extended deadline of Oct. 1, 2015. A survey of 1,100 organizations found more than half of respondents are uncertain of the actual deadline and more than half have not yet completed end-to-end testing. Another survey of 271 providers from eHealth Initiatives, Greenway Health and AHIMA found only 34 percent of respondents had completed internal testing and only 17 percent had completed external testing.
14. Medicare fee-for-service end-to-end testing performed from June 1 through June 5 was largely successful, with 90 percent of claims accepted from 1,128 participants. Another round of testing is also available July 20-24.
15. ICD-10 is already under revision and the next version, ICD-11, is expected to be released in 2017.
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