ICD-10 Info Series – Part 1

An old saying goes that “laws are like sausages, it is better not to see them being made.”  The decision to transition from ICD-9 to ICD-10 by the Center for Medicare and Medicaid Services (CMS) is no exception to this saying and most likely the finished product will not be appetizing to most healthcare providers either.


To first comply with this regulation you must first know what it actually means to your practice. ICD-10’s goal is to assist providers in adapting to the changing and more detailed world of modern disease diagnosis. To accomplish this feat, ICD-10 will include almost 69,000 diagnosis codes compared to 13,000 ICD-9 codes. Many of these new codes reflect changes in medical diagnosis but the majority attempt to provide a more specific and in depth classification of existing aliments.

This transition will inevitably mean more cost to healthcare providers who must now find the regulation, understand it and implement a training regime so that their practices are in compliance. This burden is especially heavy on smaller practices that do not have the administrative infrastructure that larger practices and hospitals currently have in place.

Now you may believe that your practice is not subject to the new 1CD-10 codes or that you are immune because you receive reimbursement from only commercial insurance payers.  Denial is always present when uncomfortable change is developing. Please take heed though, that all “covered entities” under HIPAA are subject to ICD-10. This includes healthcare providers, all payers (commercial and governmental) and other entities such as software vendors and billing companies. Denial is a necessary step to acceptance and eventually compliance.

CMS has set several deadlines for providers to comply with the new regulation. First, all electronic claims must conform to HIPAA transaction 5010 standards by January 1, 2012. This change establishes the technical groundwork for the use of ICD-10 codes, which become mandatory on October 1, 2013. If you are not a big believer in bureaucratic efficiency and believe that these dates will inevitably be extended (as they already were extended for 2 years in 2009), please note that CMS is adamant that there will be no further extensions to these deadlines.

To further buttress this point, CMS has even begun sponsoring training events such as the sardonically named Code-a-thon in April of 2011. CMS is also providing national provider conference calls and training materials to attempt a smooth transition from ICD-9. All evidence is pointing to CMS’s seriousness in this transition. Developing a plan for your practice now will blunt any of the hardships that will arise once full implementation of ICD-10 occurs in October of 2013. Because as with anything coming out of Washington, the devil is always in the details.

This is just Part 1 of my discussion on ICD-10 implementation.

Be sure to read my next blog post in which I will discuss the steps your practice can take to comply with 1CD-10.