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What Medical Providers need to know about the Switch to Icd 10

The Health and Human Services Department (HHS) initially mandated implementation of ICD-10 as a replacement for ICD-9, which constitutes an overhaul of the medical coding system, effective October 1, 2011. This has since been pushed back to October 1, 2013.

ICD-10 stands for the International Statistical Classification of Diseases and Related Health Problems 10th Revision, a World Health Organization (WHO) system of classifying diseases, symptoms, procedures, etc. alphanumerically, in place since 1993. However, in the context of the U.S. health care system, it refers to a much more elaborate set of formal modifications to that WHO system of classification, called ICD-10-CM (the CM standing for Clinical Modification). The WHO system, for instance, allows for up to 16,000 codes; the U.S. version of ICD-10 will allow for up to 155,000.

The high number of possible codes is one of the main reasons the U.S. is switching to ICD-10. Its present ICD-9 system is already running out of codes as research continues to come up with new diagnoses and procedures that need to be catalogued.

The level of detail provided by the new codes will facilitate implementation of electronic health records. Its proponents describe it as some short term expense and painful adjustment, leading to long term efficiency, sophistication, and savings.

Health care providers need to be aware of the magnitude of the changes. Switching to ICD-10 is relevant to all aspects of health care delivery, from the initial patient registration to final billing. Everyone from doctors, to hospital administrators, to insurance companies, to medical billers and more will need to learn this new system.

In addition to the necessary human training, the changes in the coding system, medical records, billing, and other analytic and decisionmaking systems will require that information technology systems be significantly upgraded if not replaced altogether.

Today, many medical practices, especially smaller ones, do not employ a specialist in coding specifically. But with the new system, the number of practices who will find it necessary to do so should increase substantially.

Everyone involved in the health care system should anticipate certain inefficiencies, communication problems, etc. during the adjustment period. There may, for instance, be an increase in (unjustified) claim denials by insurance companies due to people filling out the wrong codes or misinterpreting the unfamiliar codes, necessitating follow ups and multiple efforts to put claims through.

During the transition phase, it’ll be advantageous for as many people in the health care system as possible to be familiar and comfortable with both ICD-9 and ICD-10, since the switch will not be instantaneous and total.

No doubt, the switch to ICD-10 will mean a lot of headaches for a lot of people, but it should also put the system of medical coding on a much sounder footing moving forward.


“HHS plans switch to ICD-10 codes starting Oct. 1, 2011”

“ICD-10 FAQ”

“Ten Things to Know About ICD-10 Implementation”