Importance of ICD-10

by Sandy Fuller, RHIA, MA, FAHIMA

“Which of these vague codes in these vague categories is the one I should use?”  This is a common question posed by coders today using ICD-9-CM diagnosis and procedure codes. According to Sue Bowman, RHIA, CCS, director of coding policy and compliance at AHIMA, that points to improved data quality as one of the key outcomes of the switch to ICD-10. Bowman and Nelly Leon-Chisen, RHIA, director of coding and classification at the American Hospital Association—both members of the cooperating parties who oversee maintenance of ICD-9-CM—spoke at AHIMA’s ICD-10 Summit: Beyond Compliance to Strategic Advantage, held April 16-17 in Washington, DC. According to Bowman and Leon-Chisen, improved data quality is only one of a long list of benefits the US will see in making this move. ICD-10-CM has these intrinsic benefits over the current system:

• Greater level of specificity and clinical detail, and improvements in the capture of advances in medical technology
• Medical terminology and classification of diseases have been updated to be consistent with current clinical practice
• Comparability between mortality and morbidity data

Leon-Chisen says, “Medical coding is there to help present a picture…” And with the breadth of use of the coding system today, improved data will support a host of healthcare needs including:

• Measuring the quality, safety, and efficacy of care
• Designing payment systems and processing claims for reimbursement
• Conducting research, epidemiological studies, and clinical trials
• Setting health policy
• Operational and strategic planning and designing healthcare delivery systems
• Monitoring resource utilization
• Improving clinical, financial, and administrative performance
• Preventing and detecting healthcare fraud and abuse
• Tracking public health and risks

ICD-10 will allow for increased adoption and benefit from new technologies as well. It is designed to work with structured terminologies like SNOMED-CT which could accelerate the development and adoption of computer assisted coding. The increased specificity will allow for increased electronic data retrieval that will maximize the investment in databases and reduce the reliance on secondary record abstraction. For example, the diagnosis codes will indicate left and right, whether this is a new condition or a previous condition with current sequelae, and in some cases combine related conditions. The procedure codes allow for very specific information about the body part involved, the approach for a specific procedure, the device used, and the basic procedure performed.

Although ICD-10 is based on the same classification structure as ICD-9, both were originally developed by the World Health Organization and are modified for use in the US (ICD-9-CM diagnosis codes and ICD-10-CM). ICD-10-PCS is a completely different coding system developed separately so the speakers cautioned not to expect it to look the same as the third volume of ICD-9-CM. Both ICD-10-CM and ICD-10-PCS are comprised of seven digit alpha-numeric fields that allow for an expanded and therefore more specific set of codes.

Both Bowman and Leon-Chisen have been advocating for the move to ICD-10 for years and are excited that the date is set for this important change. They are now fully engaged in the decisions that are required to ensure success in the transition.

Sandy Fuller, RHIA, MA, FAHIMA, is the senior vice president and chief operating officer at AHIMA.