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A primer on ICD-10

On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. This transition is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). The new code set represents a fundamental shift not only for coders and healthcare providers but will also change the way payers do business. Payer business processes affected by the ICD-10 implementation include product development, network development for enrollees and payers, medical resource management, fraud and abuse detection, customer inquiries, EDI, information systems and knowledge management among many others. This is excluding the initiatives that healthcare insurance payers will undertake to keep in step with the changes put forth by the Affordable Care Act (ACA) or popularly known as “Obamacare” Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, as well as other necessary investments. All these factors make it absolutely essential to understand the differences between ICD-9 and ICD-10. Here are a few areas where they differ: Areas of difference

ICD –9

ICD –10

Number of diagnosis codes

14,000

Over 68,000

Length of the Code (Digits)

3 – 5 digits

3 – 7 digits

Number of procedural codes

4,000

Over 72,000

Code Information

Level of specificity for each code

First 3 digits similar to ICD - 9, however the rest denote specifics such as anatomy, surgical approach, laterality, chronic Vs. acute, etc

Type of code

3 – 4 numbers

Alphanumeric & 7 characters

It is expected that providers, payers, EDI clearing houses, administrative oversight and research agencies will be working to identify the right partners such as ICD-10 consultants, outsourcing partners, technology vendors and internal teams to be in time for the already once revised deadline.

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Global Payer Resource- Healthcare Payer Services- A primer on ICD-10