ICD-10-CM (based on the International Classification of Diseases, 10th edition, Clinical Modification) is a standard set of codes used for conveying a patient’s clinical profile, if you will. Defined codes are used primarily to facilitate the gathering of data, its analysis, benchmarking and eventual use in health planning and policy. To be honest, the purpose of ICD-9-CM was the same; the big difference is that the specificity of ICD-9-CM codes pales in comparison to ICD-10-CM. (Imagine…. ICD-9-CM has approximately 14,000 diagnosis codes; ICD-10-CM has over 70,000!)
Many other countries have been using ICD-10 for some time, and the US is late to the game. By adopting the use of this new code set, the US will be able to benchmark and compare its population’s morbidity and mortality to those in other countries.
The widespread use of ICD-9 (with the exception of workers’ compensation cases) will end on September 30, 2013. ICD-10 kicks off on October 1, 2013 with no grace period. Although the short-term changes affect software vendors and clearinghouses – who are busy upgrading systems – the long-term impact to providers will be significant.
The biggest challenge for clinicians will be in documentation. (If you’ve been in this business long enough, you know this is always the issue!) With such a huge increase in the number of diagnoses, it stands to reason that the amount of specificity required in the provider’s documentation will also be great. For example, one change that accounts for 62% of the fracture codes, and 36% of all ICD-10 codes, is specifying ‘right’ and ‘left’. This is a fairly simple change for a physician to make in his/her documentation, and one that can be started right now.
Other changes require time and education to coach new skills. One area that is fraught with potential challenge is the creation of combination codes. These require clinicians to link conditions that have associated symptoms or complications. The positive aspect is the reduced number of diagnosis codes required to report the condition; the difficulty will be in the provider’s ability to successfully document in a manner that links conditions appropriately. As a side-note, one small aspect to accurate risk adjusted reimbursement for capitated providers requires providers to correctly associate manifestations to diabetes as appropriate. After almost nine years, some clinicians still struggle with this seemingly simple, and highly publicized and trained concept.