ICD-10 (short for International Classification of Diseases, tenth edition) is a clinical documentation and cataloging system owned by the World Health organization which consists of over 14,000 codes, where each code represents critical information about the different diseases, findings, causes of injuries, symptoms, possible treatments, and epidemiology, playing a vital role in enabling advancements in clinical treatment and medication.
As per the US Department of Health and Human Services, ICD-10 has been made mandatory for the medical billing service providers and healthcare industry, and physicians, to be used as a code set under the Health Insurance Portability and Accountability (HIPAA). The code set applies to everything from healthcare reimbursement to research and reporting services.
The World Health Organization (WHO) is solely responsible for developing and publishing ICD codes, while local governments and regulating bodies adopt the system. Every year, WHO publishes minor updates and rolls out major updates every three years.
History of ICD-10
The ICD has been revised and published in a series of editions to reflect advances in health and medical science over time. The first classification edition was adopted by the International Statistical Institute in 1893, known as the International List of Causes of Death back then.
It was not until 1948 that the ICD was taken under the ownership of the World Health Organization, which marked the sixth version and incorporated morbidity for the first time. Later, with the emergence of the WHO Nomenclature Regulations in 1967, it was required for all Member States to employ the most current ICD version for morbidity and mortality stats.
ICD-10 was officially endorsed in the forty-third World Health Assembly in 1990. Since then, it has been applied by more than 100 countries around the world and cited in over 20,000 scientific papers and articles. On October 1, 2015, ICD-10 was formally incorporated in the US healthcare industry, effectively replacing its predecessor, ICD-9.
Purpose and Uses of ICD-10
ICD serves as a foundation to identify clinical trends and statistics globally. Diseases, injuries, disorders, and all health conditions are listed comprehensively and organized into standard groupings allowing health care providers from around the world to compare and share information using the ICD codes.
The information base then serves as a central source of data to keep track of health records and epidemiological trends.
ICD-10 provides an improved mapping from SNOMED CT, the multilingual vocabulary of medical terminology, to capture clinical data. The mapping from SNOMED CT to ICD-10 enables computer-assisted coding in an efficient and consistent manner.
ICD-10 procedure codes serve as specific information about how a healthcare provider approached a medical procedure and what type of medical device was used. Thus, evidence-based decision-making is made possible due to the easy retrieval and analysis of available health information.
Why ICD-10?
The US has been using ICD-9 since 1979 but was found insufficient to serve the healthcare needs of the future. When compared to ICD-10, ICD-9 had limited data on inpatient procedures and medical conditions as well as a restrictive coding structure. Moreover, most developed countries had already made the transition to ICD-10 codes, which made it impossible for the US to compare local morbidity data at the international level.
The expanded categories and extensible diagnosis codes ensure a reporting system that is more robust and accurate than ever before, resulting in better clinical decisions. Tracking and measuring health care utilization as well as the quality of patient care has been considerably refined, thanks to the new code set.
Benefits of ICD-10
ICD-10 enhances the quality of data by:
- Designing payment and claims processes
- Identifying and subsequently avoiding fraud and abuse
- Arriving at key clinical decisions
- Taking measure of outcomes and care provided to patients
- Tracking public health conditions
- Improved data for epidemiological research.
ICD-10-CM vs. ICD-10-PCS
The ICD-10 in the US is split into two systems: The ICD-10-CM (Clinical Modification) and ICD-10-PCS (Procedure Coding System). Generally, when people talk about ICD-10, they are referring to ICD-10-CM, which is the code set diagnostic coding for all healthcare settings. Whereas ICD-10-PCS is specifically used for inpatient hospital procedure coding.
ICD-10-CM
- Replaces ICD-9-CM
- Enables swift processing of claims
- Over 68,000 codes
- 3-7 characters long
ICD-20-PCS
- Replaces ICD-9-CM for hospital inpatients only
- Directed towards allocation of hospital and medical billing services
- 7 characters
Importance of ICD-10
To get the maximum benefit from ICD-10, it is crucial to understand and undergo some level of education in the code set. For instance, administrations need awareness regarding the impact of ICD-10 on their workflow and productivity when it comes to billing and coding. The transition from ICD-9 and the changes in the code would require additional training for resources and deal with any staffing concerns after implementation.
Similarly, physicians should be educated on the dire need to document as per ICD-10 specifications. ICD-10 permits specific code assignment which can include the whole episode of care, trimester of pregnancy, the acuity of condition, and anatomical location. To experience the complete advantages of the ICD-10 code set, improvements in education and clinical documentation are a must.
Conclusion
The ICD-10 code set is set to improve and bring structure to the healthcare sector as a whole; nevertheless, the transition from ICD-9 is proving to be much more disruptive than anticipated.
The processes and documentation that had been part of the ICD-9 for over 35 years have to be adjusted, which means some major organizational changes. Whereas previous HIPAA mandates relied on vendors, partners, and billing services, using the new code set requires an in-depth involvement by the physicians themselves.
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