Expanded medical records coding takes effect
Today, Oct. 1, marks the official date of adoption of the tenth version of the International Classification of Diseases, or ICD-10. It’s an expanded set of medical codes for illnesses and procedures intended to bring more clarity and detail to electronic medical records (EMRs) – and to keep up with changes in technology and society.
Doctors, hospitals, clinics and nursing homes must use ICD-10 for any diagnosis or procedure performed as of today in order to get reimbursed.
The new system brings the number of diagnostic codes from 14,000 (or 17,000, depending on the news source) to 68,000; inpatient hospital procedure codes jump from 4,000 to 87,000.
ICD-10 is the latest iteration of a system developed and copyrighted by the World Health Organization. The predecessor, ICD-9, launched in 1979, is no longer adequate to document advances in medical treatments and technology.
The United States is one of the last industrialized nations to adopt ICD-10 and its implementation was delayed three times. The federal Centers for Medicare and Medicaid Services (CMS) and the American Medical Association teamed up to help the medical community get ready to use the system.
Providers have a grace period in which they can use ICD-9 to code all services delivered before today, but must use ICD-10 for services performed today or after, or they will not get paid.
As of today, CMS requires ICD-10 codes for all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after today. Commercial insurers reportedly will work with both ICD-9 and ICD-10 codes until all claims for treatment delivered before today are processed.
The cost of conversion to ICD-10 has run to six figures for small medical practices, and news reports detail how some have taken out multi-million-dollar lines of credit in anticipation of reimbursement delays. For hospitals, conversion has run into the millions. However, it’s expected that over the long term, the U.S. healthcare system will reap the benefits of more specific documentation of health conditions, through more specific, result-oriented reimbursements. This would include increased reimbursements for patients in health plans that receive per-member, per-month fees for care, because payments are adjusted to reflect severity of patient illnesses.
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