ICD-10: What You Need to Know to Manage the Change

Benefits of ICD-10

ICD-10-CM is the new set of diagnostic codes that all U.S. physician practices must use starting on October 1, 2013. Total ICD-10 codes are expanding from approximately 24,000 to more than 155,000 codes. More specifically, the ICD-10-CM code sets are expanding to approximately 68,000 — a little over a five-fold increase from ICD-9-CM. The expansion may benefit the delivery of care by indicating more precisely the diagnosis, and will better match the payment for care to the care delivered. In time, it will promote greater efficiencies in care documentation and claims processing.

How Does ICD-10 Affect Me?

A foundational regulatory change is on its way. The change to an expanded code set for diagnoses and procedures, ICD-10-CM and ICD-10-PCS, will bring sweeping changes to the processes and IT solutions used by providers and payers, clearinghouses and software vendors. The Oct.1, 2013 mandate will affect all aspects of a provider’s operations since the provision of care, along with the appropriate diagnosis and procedure codes, drive the delivery and business of healthcare.

Business Issues:

• Training: Significant time and effort will be required to bring coders and physicians up to speed on the new ICD-10 requirements - new codes sets, required documentation, technology. Additional specificity will require expanded knowledge of anatomy and physiology.
• IT systems: A variety of systems, including practice management, electronic health record and billing, must be modified to support ICD-10.
• Contracts and coverage determination analysis: Health plans will likely modify coverage determination policies and reimbursement schedules and contracts may be altered.
• Cash Flow: Physician cash flow is likely to be disrupted "for a considerable period of time."

ICD-10 Changes*

• Volumes of diagnosis codes will grow from 13,000 to approximately 68,000
• Conditions have been regrouped
• Bilateral sites have a new laterality code
• Expanded injury codes
• Combination coding for diagnosis and symptoms/manifestations
• Expanded post-op complication codes
• *Not the full list of changes