Why has the U.S. decided to move from ICD-9 to ICD-10?

Key issues in adopting ICD-10- CM are:

  • ICD-9 is 30 years old and is outdated.
  • ICD-9 is running out of spaces for new codes. Codes added in recent years are in the wrong chapters because the correct chapters were full, with nowhere to add new codes.
  • ICD-9 codes cannot reflect current and evolving medical technologies.
  • The current codes are limited in their descriptions. New codes will allow for a greater level of detail, including etiology, manifestation, and laterality.
  • ICD-9 does not provide the increased level of detail needed for emerging needs like biosurveillance and competitive purchasing.
  • ICD-9 lacks the ability needed to assign additional detailed classification, new diseases, and other advances.
  • ICD-9 uses terminology inconsistently and lacks codes for preventive services.
  • ICD-9 limits the precision of diagnosis-related groups, resulting in different procedures grouped together in one code.
  • ICD-10 increases the degree of detail that HHS needs to measure quality outcomes, such as the quality of performance measures needed for hospital reporting programs. The exactness and accuracy currently unavailable using ICD-9 will be an integral benefit of claims-based, value-based provider initiatives and payment.
  • ICD-10-CM provides much more information and detail within the codes.
  • ICD-10-CM facilitates timely electronic processing of claims by reducing requests for more information.
  • ICD-10-CM offers an improvement in coding primary care encounters, external causes of injury, mental disorders, neoplasm, and preventative health.
  • ICD-10-CM reflects advances in medicine and medical technology.
  • ICD-10-CM captures more detail on socioeconomics, ambulatory care conditions, problems related to lifestyle, and results of screening tests.
  • ICD-10-CM provides more space for future expansion.
  • ICD-10-PCS is detailed enough to describe complex medical procedures.
  • ICD-10-PCS uses unique and precise codes to differentiate body parts, surgical approaches, and devices used.
  • ICD-10-PCS can be used to identify resource consumption differences, such as outcomes for different procedures and describing precisely what is done to the patient.
  • The transition to ICD-10 will enable the use of interoperability standards specified by the Healthcare Information Technology Standards Panel, include the use of SNOMED-CT® (Systemized Nomenclature of Medicine-Clinical Terms). Benefits of using SNOMED-CT® are increased when used with ICD-10-CM and ICD-10-PCS. Mapping of these to use these two code sets are underway.

ICD–10 and the Development of ICD–10–CM and PCS
The ICD–10 code sets provide a standard coding convention that is flexible, providing unique codes for all substantially different health conditions. It also allows new procedures and diagnoses to be easily incorporated as new codes for both existing and future clinical protocols. ICD–10–CM and ICD–10–PCS provide specific diagnosis and treatment information that can improve quality measurements and patient safety, and the evaluation of medical processes and outcomes. ICD–10–PCS has the capability to readily expand and capture new procedures and technologies.

Expectations of the new ICD-10 code sets:

  • Allow more accurate definition of services and provide specific diagnosis and treatment information for a wider variety of illness and disease
  • Provide more accurate data for tracking, reporting, reimbursement, trending, and purchasing decisions
  • Reduce claim rejection, improve disease management, and allow for more accurate and comprehensive revenue

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.