The switch from ICD-9 to ICD-10: When and why
Health Insurance Portability and Accountability Act of 1996 (HIPPA) required the secretary of the department of Health and Human Services (HHS) to establish nationwide standards for electronic data exchange. To this end, HHS mandated the nationwide use of ICD-10 for all inpatient medical coding and billing purposes after October 1, 2015.
The change was originally planned for 2013. After, the American Hospital Association (AHA) petitioned congress, the official transition date was moved to October 2014. In 2014, the transition date slipped again to October 2015. On October 1, 2015, the transition to ICD-10 finally took place.
What Was Wrong With ICD-9?
ICD-9 was used for over 20 years and became the accepted language of medical coders in the U.S. It is surprising how a list of seemingly meaningless codes can describe a patient’s entire diagnosis and treatment at a hospital. However, there were issues with ICD-9. Many codes were out-of-date, seldom used codes and there were sometimes no code for common diagnoses and procedures.
The best solution was to adopt a new, more modern medical coding codeset. The Department of Health and Human Services decided to transition to ICD-10 – a newer, more detailed codeset that had already been adopted by many countries around the world.
Why ICD-10?
ICD-10 codes capture a much higher level of detail than was possible with ICD-9. While there are approximately 14,000 ICD-9 codes, there are over 70,000 ICD-10 codes. This level of detail helps hospitals to bill insurers and the Center for Medicare & Medicaid Services (CMS). Additionally, the high level of detail helps HHS and other healthcare researchers to perform lifesaving statistical analysis of diagnosis trends. The statistics can help healthcare professionals to improved resource allocation for cost savings and better healthcare outcomes.
ICD-10 is not perfect. There are many codes that are comically specific and unlikely to be ever used very often – such as W61.11XA Bitten by Macaw, subsequent encounter.
The increased number of codes means medical coding has become much more difficult. There are many more mistakes that result in incorrect billing, especially at first. Additionally, because such a high level of detail is needed to code ICD-10 correctly, doctors must now spend more time writing more accurate documentation. In many cases, more accurate documentation is a good thing, but it is a bit overboard when a coder has to ask a doctor to go back and specify whether an injury was caused by “Balloon crash injuring occupant” (V96.01) or “Forced landing of balloon injuring occupant” (V96.02).
ICD-10 has its pros and cons. Overall, most health care professionals are confident that ICD-10 will work out for the best. Once medical coders and doctors become familiar with ICD-10, things should start going more smoothly. It will only take time for ICD-10 to become as fluent as ICD-9 was. However, until then, hospitals will be on pins and needles ensuring their medical codes are accurate and billing amounts are correct. Hopefully the increased administrative burden will be worth the benefits of ICD-10.