ICD-10

The latest cataloging system for medical coding 

On October 1, 2015, the Centers for Medicare & Medical Services (CMS) mandated that the ICD-10 cataloging system was to replace the current ICD-9 system. This transition has been a source of stress and frustration for many doctors, primarily independent and private practice doctors. Thus it is imperative that physicians use an EHR that can seamlessly undergo the ICD-9/ICD-10 transition.

What is ICD-10?

ICD-10 is the 10th revision of the International Classification of Diseases. The ICD codes are published by the World Health Organization (WHO) and are used worldwide as a clinical cataloguing method. Within the healthcare industry, healthcare providers, IT professionals, insurance carriers, and government agencies use ICD codes to properly document diseases on medical records, track epidemiological trends, and make medical reimbursement decisions.

While the old ICD-9 codes used 3-5 characters consisting only of numbers, the new ICD-10 system uses codes with 3-7 characters in an alphanumeric combination, thus allowing for greater specificity in making diagnoses. In the U.S., ICD-10 codes are split into 2 systems: ICD-10 CM (Clinical Modification) is used for diagnostic purposes while ICD-10 PCS (Procedure Coding System) is used for inpatient hospital procedure coding. These U.S.-specific adaptations conform to WHO’s ICD-10 layout while allowing for additional specifications to aid with the delivery of healthcare in the U.S. (The U.S. had taken a similar approach with ICD-9-CM and ICD-9-PCS)

Transitioning to ICD-10 from ICD-9

There was a critical need in the medical community to improve the clinical cataloging system. Doctors and experts say that ICD-9 has become obsolete in the face of the rapid advancements being made in medicine and that the ICD-9 system simply lacks the capabilities to account for modern medical practices. ICD-9 doesn’t have the specificity to make accurate clinical diagnoses and fails to take into account many new medical devices. In addition, most other developed nations have already adopted ICD-10, so it is important that the U.S. use the ICD-10 system as well in order to make our medical data compatible with that of other countries.

ICD-10 has many advantages over ICD-9:

  • ICD-10 has approximately 69,000 codes compared to the 14,000 ICD-9 codes. This nearly 5-fold increase in codes allows healthcare providers to enter far more nuanced diagnoses into electronic medical systems and thus improve the delivery of healthcare.
  • The greater level of detail in the ICD-10 codes now accounts for laterality, severity, and complexity of disease conditions, which allows for more specificity and accuracy. For example, if a patient broke a femur, the ICD-10 system can specify the right or the left femur while ICD-9 cannot. ICD-10 can provide additional information such as whether the patient is being seen by a caregiver and how the injury or disease is progressing.
  • ICD-10 provides higher quality information for measuring the quality, safety, and security of healthcare service.
  • ICD-10 codes hold critical information about diseases, epidemiology, external causes of injury, signs and symptoms, complaints, abnormal findings, treating conditions, managing health, and social circumstances.
  • The ICD-10 system improves efficiency, reduces coding errors, and decreases cost
  • ICD-10 contains updated and revised medical terminology

The ICD-10 transition does not affect or change the American Medical Association’s CPT (Current Procedural Terminology) codes used for outpatient procedures.

What do Independent and Private Practice Physicians Need to Know About ICD-10?

It is imperative that doctors switch to the ICD-10 system for a number of procedural, security, and monetary reasons.

  • The transition from ICD-9 to ICD-10 is mandatory according to the CMS. Claims for all health care services and hospital inpatient procedures performed after October 1, 2015 must use ICD-10 diagnosis and inpatient procedure codes, otherwise they will not be processed. This means that claims dated after October 1, 2015 that fail to use ICD-10 codes will not be recognized and that physicians will NOT be paid for any of those claims of services. (1)
  • According to the CMS, all parties covered under HIPAA are required to use ICD-10. This means that for doctors to retain their HIPAA compliance, they must switch to the ICD-10 system. (2)
  • Though many independent and private practice physicians may balk at the cost for transitioning to ICD-10, experts maintain that the benefits of implementing ICD-10 outweigh the costs. An independent study conducted by Rand showed that within the first few years of installing ICD-10, the benefits would exceed the implementation costs. Furthermore, the study showed that the cost of doing nothing may eventually outweigh the cost of implementing ICD-10. In fact, delays in adopting ICD-10 will cause an increase in future implementation costs due to required system and application upgrades. (3)

Therefore, it is in every physicians’ best interest to begin using ICD-10 in their medical practices.

How can Elation help small and solo practitioners?

Many doctors, especially solo practitioners or those with small to medium practices, may balk at the dramatic increase in codes. But with the right EHR, doctors can seamlessly implement the ICD-10 system into their practice and avoid the impending stress and confusion that this transition threatened to bring. Elation has created an EHR to specifically meet this need so doctors can minimize any loss in productivity or revenue when they install ICD-10.

Here is how Elation’s EHR’s can help doctors transition to ICD-10:

  • There is no need to download or install any new software—our EHR will be automatically updated to implement ICD-10
  • Doctors do not need to reconfigure reimbursement practices—our EHR will ensure that your ICD-10 transactions are compatible with your reimbursement practices
  • Elation’s EHR makes the ICD-10 transition easy for practices: if healthcare providers are not yet comfortable or familiar yet with ICD-10 codes, they can enter ICD-9 or SNOMED codes into our EHR and output ICD-10 codes. This ensures that physicians will not miss a payment due to lack of compliance with ICD-10.

Independent and small practice physicians can depend on Elation’s EHR for a seamless transition to ICD-10 to minimize the stress of implementing a new medical coding system so they can devote their attention to caring for patients.