Thoughts on the ICD-10 Transition

According to Confucius, “The beginning of wisdom is to call things by their proper names.”   Imagine a world without a standard nomenclature for describing diseases. The terms we use to describe medical conditions would be ambiguous and subject to change according to the whims of the latest school of thought. Convincing people to pay us for treating these condition would hinge on providing detailed narrative descriptions. Now consider how the lack of a consistent and universally accepted naming system would undermine the progress of medical science. This world is not so hard to imagine. It’s the world that existed prior to the Twentieth Century—a world afflicted with consumption and dropsy and grippe.

The science of medicine was late to the game of creating a system for categorizing it’s objects of study. In biology, the system of classifying living organisms was refined by Carol Linnaeus in the early 1700s, but the roots of binomial nomenclature extend all the way back to Aristotle. The roots of the International Classification of Disease (ICD) begin in England in 1837, with passage of the Registration Act, and the subsequent appointment of William Farr, one of the founders of medical statistics, to the office of Registrar-General.

Farr was frustrated by the lack of a uniform nomenclature for recording the causes of death. He stated in his first report that diseases were “denoted by three or four terms, and each term has been applied to as many different diseases.” Farr urged the adoption of a standard nomenclature, and remarked that such a system would be as useful to the health sciences as standardized weights and measures were to the physical sciences. Although Farr‘s system of classification never achieved international acceptance, his principle of classifying diseases based on etiology followed by anatomical site survives to this day.

The International List of Causes of Death, the grandfather of the ICD, was adopted by the International Statistical Institute in Chicago in 1893. Four years later, the American Public Health Association recommended that the ICD be used by all registrars of vital statistics in the United States, and that the classification be “revised every 10 years, to keep up with the progress of medical science.” The ICD has been revised 10 times since then with its scope gradually expanding to encompass all causes of morbidity and mortality.

Medical science has certainly progressed over the past century. Unfortunately, our system of nomenclature is stuck in 1975, the year when ICD-9 was first published. Most of the world has already switched from ICD-9 to ICD-10. We’ve been able to put off the transition for a few years, but it appears that there will be no further delays. Unless Congress acts to delay the transition, all claims submitted on or after October 1, 2015, must use ICD-10 codes.

There are plenty of good reasons to switch from ICD-9 to ICD-10. The ICD-10 code set will allow for better tracking of population health, and provides more detail for documenting laterality, severity, and complexity of disease. It also brings our terminology up to date, and makes it more consistent with current technology and standards of care. Other claimed benefits include reducing the need for manual review of health records to perform research and data mining, and reducing the need for providing supporting documentation when filing claims.

Unfortunately, the downsides of converting to ICD-10 are considerable. I’m sure you have heard the dire predictions. Some of these concerns may prove to be as exaggerated as the panicked warnings that preceded the “Y2K bug.” The American Medical Association has claimed that transitioning to ICD-10 could cost a small physician practice more than $100,000. In contrast, a recent analysis published by the American Health Information Management Association suggests that the cost per physician might be less than $2000.

The Centers for Medicare and Medicaid Services recommends taking the following steps to prepare for the ICD-10 transition:
  • Identify current systems and work processes that use ICD-9 codes, including clinical documentation, encounter forms and superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols.  
  • Talk with your practice management system vendor about accommodations for ICD-10 codes. Confirm that your PM system has been upgraded to Version 5010 standards, and ask what updates they are planning to make for ICD-10, and when they expect to have it ready to install. Check your contract to see if upgrades are included as part of your agreement.  
  • Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition. Ask about their plans for ICD-10 compliance and when they will be ready to test their systems for the transition.  
  • Talk with your payers about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD-9 codes, payers may modify terms of contracts, payment schedules, or reimbursement. 
  • Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.  
  • Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, online courses, webinars, and onsite training. 
  • Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, reprinting of superbills, trainings, and related expenses. 
  • Conduct test transactions using ICD-10 codes with your payers and clearinghouses. Testing is critical. You will need to test claims containing ICD-10 codes to make sure they are being successfully transmitted and received by your payers and billing service or clearinghouse. Check to see when they will begin testing, and the test days they have scheduled.
Regardless of the costs and disruptions of the ICD-10 transition, keeping up with the standard nomenclature of our profession is simply part of the cost of doing business. One of the main reasons this transition is expected to be so difficult is because we have put it off for far too long. Rather than hoping for another Congressional reprieve, the time is now to prepare yourself and your office staff for the transition.

This article was published in South Carolina Family Physician.