US Healthcare System is very keenly introspecting on ICD -10 transitions and October 2014 implementation deadline. All involved players are both apprehensive and anxious to be the part of the change as well as to the adaptability to the foresaid changes. This is been compared mostly with theY2K change, which drew much speculation and confusion.

On the contrary, ICD-10 transition is sketched systematically, with enough time to inculcate changes, with detailed and more described diagnosis, signs and symptoms for a very effectively documented medical report and thus coding and finally a better reimbursement.
However the transition to ICD-10 does not directly affect provider use of the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.

Partners of the change
• Hospitals
• Health care practitioners and institutions
• Health insurers and other third-party payers
• Electronic-transaction clearinghouses
• Hardware and software manufacturers and vendors
• Billing and practice-management service providers
• Health care administrative and oversight agencies
• Public and private health care research institutions

Restrictions of ICD-9

• ICD-9 has several limitations that prevent complete, precise coding and billing of health conditions & treatments.
• The 30-year-old code set contains outdated vocabulary and is incoherent with current medical practice.
• The code length and alphanumeric structure limit the number of new codes that can be shaped and many ICD-9 categories are already full.

The codes themselves lack specificity and detail to support the following:

• Precise anatomical descriptions
• Differentiation of risk and severity
• Key parameters to differ manifestations
• Optimal claim reimbursement

The lack of detail limits the ability of payers and others to analyze information such as health care utilization, costs and outcomes, resource use and allocation and performance measurement.

The codes do not provide the level of detail necessary to further streamline automated claim processing, which would result in fewer payer-physician inquiries and potential claim payment delays or denials.

Merits of ICD-10

By contrast, ICD-10 provides more specific data than ICD-9 and better reflects current medical practice. The added detail embedded within ICD-10 codes informs health care providers and health plans of patient incidence and history, which improves the efficiency of case management and care coordination functions. Accurate coding also reduces the volume of claims rejected due to indistinctness.

• ICD- 10 improves operational processes across the health care industry by classifying detail within codes to accurately process payments and reimbursements.
• The transition also updates the terminology and disease classifications to be consistent with current clinical practice and medical and technological advances.
• Increased flexibility for future updates is indispensable and hence this is taken into account during the up gradation.
• Coding accuracy and specificity is enhanced to classify anatomic site, etiology and severity.

ICD-10 makes sure that it support refined reimbursement models to provide equitable payment for more complex conditions and thus streamline payment operations by allowing for greater automation and fewer payer-physician inquiries, decreasing delays and inappropriate denials.
This provide opportunities to develop and implement new pricing and reimbursement structures including fee schedules, hospital and ancillary pricing scenarios based on greater diagnostic specificity.

Moreover, ICD-10 endows payers, program integrity contractors and oversight agencies with opportunities for more effective detection and investigation of potential fraud or abuse and proof of intentional fraud. This new version promise more detailed data to better analyze disease patterns and track and respond to public health outbreaks.

The Challenge

The challenge which lies ahead of the move to the ICD-10-CM is that, this will increase documentation activities about 15 percent to 20 percent. This translates into a permanent increase of 3 percent to 4 percent of physician time spent on documentation for ICD-10-CM.

As the study notes:
This is a permanent increase, not just an implementation or learning curve increase. It is a physician workload increase with no expected increase in payment, due to the increased requirements for providing specific information for coding. Electronic health record systems will not be able to eliminate the extra time requirement.”

Tips for a successful transition

A successful transition from ICD-9 codes to ICD-10 codes on October 1, 2014 will require significant planning. At a minimum, your organization should consider the following activities:

Ensure top leadership understands the breadth and significance of the ICD-10 change.
Assign overall responsibility and decision-making authority for managing the transition.
This can be one person or a committee depending on the size of your organization.
Plan a comprehensive and realistic budget. This should include costs such as software upgrades and training needs.

• Contact vendors, physicians, affiliated hospitals, clearinghouses, and others to determine their plans and readiness for ICD-10 transition.
• Adhere to a well-defined timeline that makes sense for your organization.
• Inform physicians/staff of upcoming changes and the practice’s implementation plans.
• Perform an impact assessment and identify potential changes to existing work flow and business processes.
• Evaluate the effect of ICD-10 on other planned or on-going projects and determine business and technical implementation strategy.
• Determine anticipated testing time and schedules. If vendor(s) provide solution, then engage immediately.
• Seek resources from CMS, professional and membership organizations to help with transition.
• Conduct internal testing. This must be a coordinated effort with internal coding, billing, and technical resources and vendor resources.
• Continue to educate staff on changes in documentation requirements from health plans.
• Begin external testing at regular intervals.
• Complete external testing and continue training for coders as needed.
• By Oct 1, 2014, ICD-10 system could be implemented for full compliance. ICD-9 codes will continue to be used for services provided before October 1, 2014.

We wish everyone a successful transition to ICD-10, if you need any assistance on coding please feel free to reach us at


Manager – Bristol Coding Team