CMSA Today - Issue 7, 2015 - (Page 10)
Are We Ready?
BY PAT STRICKER, RN, M.Ed
he impending change to ICD-10 has caused an unusual amount of angst for the health
care industry. Given the overall changes and highly sophisticated health care procedures
available today, should implementing a new set of diagnostic codes generate this kind of
turmoil? Sure, they have caused a lot of extra work to prepare for the change, they will cause a
slowdown in productivity initially when they are implemented, and they will cause some issues
with payments, but do they deserve this much attention? Aren't we always in the middle of some
type of major change in health care?
We made it through major changes in
the past, such as Medicare, Medicaid, ICD-9,
managed care, DRGs, and now the Affordable
Care Act. They didn't seem to be that
catastrophic, so why are we so worried? Most
other countries implemented ICD-10 years ago.
Once implementation is completed, we will
probably look back and say "that wasn't so
bad." Remember how difficult it was when
computers, and then cell phones, started to
invade our quiet, organized lives? Most of
us resisted them. Now, can you even think
of not having them? They run our lives.
Change is inevitable, and we will get through
This article is not meant to be a tutorial on
how to get ready for ICD-10. It's too late for that.
It is also not meant as training on the specifics
of how to use the codes. I assume you have
already had training on that (or at least I hope
you have). The intent of this article is to provide
you with some hints and tips on how to get to
the finish line, provide some light-hearted facts
and thoughts about ICD-10, and make you feel
good about where you are in the process. I'd
like us to take a few deep breaths and relax
before the "big day." If you are all set for the
October 1 date, that's terrific! If you are almost
ready - keep going, the finish line is near! If
you aren't ready, all I can say is good luck!
We need to keep in mind why we are moving
to ICD-10. It's not just to keep up with the other
countries that have done so years ago. We need
to make this change to improve our health
* The updated codes will provide current
terminology and specificity for the health
care being practiced now in the 21st century
versus that of the 1970s.
The specificity of the diagnosis codes will
help us collect more meaningful data about
conditions, their interventions and treatments, and their outcomes.
We will be able to better manage populations by being able to analyze the data and
use it to make quicker decisions.
Better data and the ability to measure outcomes will help drive better quality of care.
The new codes will help us move toward
value-based purchasing and payment reform.
HISTORY OF THE INTERNATIONAL
CLASSIFICATION OF DISEASES (ICD)
Let's start by looking at the history of the
ICD codes. Believe it or not, the statistical study
of disease began in the 1600s. In 1891, the
International Statistical Institute commissioned
the development of a classification of causes
of death, which became known as the
Bertillon Classification of Causes of Death. This
document continued to be updated over the
years and countries also began to collect data
on diseases, morbidity, and injuries. At the 6th
International Conference in 1948, the Causes of
Death list was combined with lists of diseases,
injuries, and morbidity. This became known
as the Manual of the International Statistical
Classification of Diseases, Injuries, and Causes
of Death. Today we would describe it as the
International Classification of Diseases (ICD-6).
The 7th version was released in 1955 and the
8th version in 1965. ICD-9 was introduced in
1975 and implemented in the U.S. in 1979 (36
years ago). Work on ICD-10 began in 1983 and
Issue 7 * 2015 * DIGITAL
the diagnosis codes were endorsed for use in
1990, with the full release in 1994. Since that
time, 138 countries have implemented ICD10 for mortality and 99 countries are using
it for morbidity.
In 1995, the U.S. made plans to implement
ICD-10, but HIPAA regulations enacted in 1996
put a regulatory hold on the process. The ICD10 codes were implemented in the U.S. for
mortality coding only (death certificates) in
January 1999. The ICD-10 implementation was
on-hold until 2003 when Health and Human
Services (HHS) was given the responsibility to
implement ICD-10 under the HIPAA standards.
After more regulatory issues and public
comment periods, it wasn't until 2009 that
HHS established ICD-10 as the new national
coding standard and set an implementation
date of October 1, 2013. (That decision only
took 13 years, and the implementation
was to take another four years!) But the
implementation was pushed back to 2014
and then finally to 2015 (19 years after we
first started to plan our transition to ICD-10).
So you can see why people just want to see it
actually happen. And just in time; ICD-11 is just
around the corner. Their release is scheduled
for 2018, but let's not think about that just
yet. We need to get ICD-10 up and running
first, and then it should be easy to transition
to ICD-11, right?
The World Health Organization (WHO)
describes the International Classification of
Diseases (ICD) as the standard diagnostic tool
for epidemiology, health management, and
clinical purposes. This includes the analysis
of the general health of population groups,
the monitoring of incidence and prevalence
of diseases and other health problems, and
providing a picture of the general health of
countries and populations. The codes are
used to classify diseases and other health
problems; to store and retrieve diagnostic
information for clinical, epidemiological, and
quality purposes; to make decisions about
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CMSA Today - Issue 7, 2015