Conservative estimates project that we will be moving from a system that contains about 14,000 diagnosis codes to a system that contains some 68,000 diagnosis codes. If youre wondering what is behind all of the angst, a little history lesson may prove beneficial.

History and Perspective

The International Classification of Diseases (or more specifically, the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, or ICD 10 Codes) is the latest in a series that has its origins in the 1850s with a collection of mortality statistics. The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893.

The World Health Organization (WHO) took over the responsibility for the ICD in 1948 when the Sixth Revision, which included causes of morbidity for the first time, was published.

The ICD is designed to promote international comparability in the collection, processing, classification and presentation of mortality and morbidity statistics. It is used to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and patient records. The reported conditions are then translated into medical codes in accordance with the classification structure and the selection and modification rules contained in the applicable revision of the ICD.

The International Conference for the Ninth Revision of the International Classification of Diseases, convened by WHO, met in Geneva in 1975. A number of innovations were included in the ninth revision, aimed at increasing its flexibility for use in a variety of situations. But, after several years, ICD 9 codes eventually ran its course. In May 1990, ICD 10 codes were endorsed by the 43rd World Health Assembly and came into use in WHO member states as early as 1994.


So, if WHO completed ICD 10 codes more than a decade ago, why hasn't it been phased in yet?

First, understand that WHOs ICD system and the system that you use for coding and billing are not one and the same. In 1979, the United States adapted the ICD 9 classification system (as many other countries have) to capture additional morbidity data, and called it ICD 9 CM (the last two letters stand for Clinical Modification). More functionally, ICD 9 CM added procedure and diagnosis codes that eventually were used for the reimbursement process of health care encounters. (The CM codes are more precise than those in WHOs ICD 9, which are needed only for statistical groupings and trend analysis.) Since the late 1980s, ICD 9 CM has been required by third-party payers for reporting the clinical diagnosis associated with the performed procedures.

In the U.S., ICD-9-CM is used to code and classify morbidity data from inpatient and outpatient records, physician offices and most National Center for Health Statistics (NCHS) surveys. NCHS and the CMS are the governmental agencies responsible for administering all changes and modifications to ICD-9-CM. An annual review process makes changes to the ICD-9-CM to further clarify some codes and to create new codes needed as a result of discoveries, medical advancements or other administrative reasons.

Despite the annual revisions, the U.S.s ICD 9 CM has begun to show its age, and a revised system was called for. In the 1990s, NCHS received permission from the WHO to create a clinical modification of the ICD 10 codes.

ICD 10 Codes: Why, and Why Now?

Fall 2008 was exciting, to say the least, with the political change sweeping our country. In the coding world, there was much excitement as well. CMS announced that the final implementation date for the expanded ICD 10 CM (diagnosis) and ICD 10 PCS (procedure) code sets would be October 1, 2011.

In response, many health care organizations around the country protested loudly, saying that this date was too soon and that the cost and time impact of implementing the ICD 10 rules would be overwhelming to our health care system. Continued debate ensued and, earlier this year, CMS postponed the implementation date to October 1, 2013. The October 1, 2013 implementation date is a firm onein other words, ICD 9 codes cannot be used to report services performed after that date. In order to avoid entities from having to maintain the capacity to work with both coding systems after that date, the implementation of crosswalks, mapping and guidelines will enable them to move from ICD 9 codes to ICD 10 codes on and after this date.

The impetus to move to ICD 10 codes comes from many different forces. ICD 9 codes are 30 years old, and are outdated. Many of the diagnostic categories are full and cannot be expanded to add new entries. And, for those categories and diagnoses that do exist, many are not descriptive enough.

Specifically, ICD 9 CM includes about 14,000 diagnosis codes. Under ICD 10 CM, there will be about 68,000 codes. The number of procedure codes will increase from some 3,800 under ICD 9 codes to about 87,000 under ICD 10 codes.

Also, the code structure itself will change. With the current ICD 9 diagnosis codes, each code has three to five digitsand most have five because we are obliged to always code to the highest level of specificity. There are 17 distinct chapters in ICD 9 codes, with all characters being numeric (except for supplemental diagnosis codes E and V in which the first character is alpha and the remainder are numeric).

ICD 10 code is a completely different system.  ICD 10 codes:

Is three to seven digits long.

Begins with an alphabetic character.

Has a numeral as the second digit.

Includes alpha or numeric digits as the third through seventh characters.

Differentiates right vs. left vs. bilateral.

Government-produced algorithms that map a specific code from the ICD 9 code to the ICD 10 code, or vice versa, have had limited success to date. But, Im hopeful that with time, they will become more accurate.

he health care system in the United States is preparing for one of the biggest challenges it has faced in decades. No, not socialized medicine or universal health care, but the overwhelming task of transitioning from the ICD 9 coding system to the ICD 10 coding system. The price tag? An estimated $83,290 for a small (i.e., three-doctor) practice. The total cost for the entire U.S. health care system? $1.64 billion.


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