Five years ago, an international visitor asked me why we were still using International Classification of Diseases, 9th Edition (ICD-9) for coding; they had been using ICD-10 for years. While I was researching an answer, I discovered that the World Health Organization (WHO) owns and publishes the ICD, which is designed "to promote international comparability in the collection, processing, classification, and presentation of mortality statistics." This includes providing a format for reporting causes of death on the death certificate. ICD also provides data about the incidence and prevalence of diseases and other health conditions in populations.
Since 1999, the National Center for Health Statistics has used ICD-10-CM, a clinical modification of classifications for morbidity purposes only, with authorization from WHO for a U.S. adaptation of ICD-10.
U.S. healthcare providers have not been using any version of ICD-10 for a number of reasons. One is that ICD-10 has too many codes with a high degree of specificity for a wide array of conditions, particularly infectious diseases that are not likely to ever be seen or diagnosed in the United States. Another explanation is that our medical records system (both manual and electronic) and health plan systems are not set up to handle complex codes with the many alphanumeric variations seen in ICD-10; programs would need to be completely rewritten. Insurers have also been accused of resisting a change to ICD-10 because they did not want to invest in revising their computer systems.
Deciphering codes
Coding a diagnosis is both challenging and frustrating when you are not able to find an exact code for your terminology. How many of our trusted codes no longer exist? For example, notices sent by Medicare or other insurers requesting additional diagnosis codes to confirm the medical indications for lab tests are annoying to a provider who believes the appropriate codes have already been given.
There are even greater changes on the horizon. One provision in the Affordable Care Act calls for streamlining the way we conduct healthcare business in the United States. The intent in simplifying processes and standardizing procedures is to minimize systemwide inefficiencies and reduce costs associated with delivering healthcare.
In January 2009, the Department of Health and Human Services (HHS) set October 1, 2013, as the date for adoption of ICD-10-CM diagnosis and procedure codes to replace ICD-9 for healthcare transactions. All providers and healthcare entities covered under the Health Insurance and Portability and Accountability Act of 1996 (HIPAA) were mandated to be in compliance by that date.
Although steps have been taken to implement changes, HHS announced last February their intent to push back the date for mandatory adoption of ICD-10. On April 9, 2012, HHS proposed a new rule that would establish a unique identifier for all health plans using a standard length and format to facilitate routine use in computer systems. The current degree of variation among insurance identifiers can lead to incorrectly routed insurance claims, rejections due to coding errors, and provider and patient uncertainty of patient eligibility. As a result of this rule, HHS confirmed the delay for adoption of ICD-10 codes until October 1, 2014, to allow providers and all covered HIPAA entities more time to prepare their electronic systems for the transition.
Less paper, more patients
No matter what the impetus, any changes that streamline administrative processes in our payment system are welcomed. One anticipated benefit of switching to mandatory electronic fund transfers, along with adopting ICD-10, is that providers will spend less time filling out forms and chasing payments, leaving more time to spend with patients. After all, the overreaching goal is to provide patient-centered care to improve quality of care.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
Editor-in-Chief
[email protected]