ICD

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ICD refers to the International Statistical Classification of Diseases and Related Health Problems, a set of codes published by the World Health Organization (WHO) to classify diseases, symptoms, and other health problems. The most basic purpose of the coding system was to classify and quantify causes of mortality. ICD-9 has been used in the United States since 1977 for reporting statistics and billing to Medicare, Medicaid, and insurance companies.(1) The code set was developed before computers were widely used to process medical data aside from billing, indexing, and statistics. The World Health Organization has since published a revised set of codes called ICD-10 in 1992. The new scheme allows for 155,000 unique codes as opposed to the 17,000 of ICD-9-CM.

ICD-10 allows for greater granularity and specificity of reporting data. In addition, the system solves many of the problems of ICD-9, most notably the problem of expandability. Previously, newly classified diseases and procedures were simply added to the end of the current list of codes. In 1998, the National Center for Health Statistics released a modification of ICD-10 for the reporting of morbidity data and thus began the process of converting U.S. government departments to the new code set.(2) In 2008, CMS announced that all diagnosis data for claims processing would have to use ICD-10 beginning in October 2011.

The proposed implementation is being met with resistance by U.S. providers and insurers due to the cost of implementation and increased administrative complexity. One estimate puts the cost at $285,000 for a 10-physician practice over the 3-year implementation period between 2008 and 2011.(3) Although HHS's goal is to reduce improper or inaccurate charges, the transition is expected to result in two-to-threefold increases in rejected claims in the short-term. Some believe the timeframe for the changeover is unworkable, although the legislation by Congress in 2006 proposed the change be completed by 2009.(4)

References

1. AAFP Challenges Wisdom of Adopting ICD-10. American Academy of Family Physicians. [1]

2. Latour, Kathleen M and Eichenwald-Maki, Shirley, eds. Health Information Management: Concepts Principles, and Practice. 2nd Edition. Chicago: AHIMA, 2006.

3. Switch to ICD-10 codes could be costly: HHS proposal calls for ICD-10 implementation by 2011. Renal Business Today. [2]

4. Rushing ICD-10 Implementation Would Likely Cause Improper and Fraudulent Medicare Payments To Soar, New Report Finds. BlueCross BlueShield Association. [3]

February 2009 Update

Presently ICD-9-CM is used within the United States to code inpatient diagnoses and procedures as well as outpatient diagnoses. This is the U.S. clinical modification of standard ICD-9 from the WHO (World Health Organization). It contains volumes 1 and 2 for diagnosis codes and volume 3 for procedure codes and is commonly used for reimbursement and reporting purposes. Volume 3 is specifically part of the clinical modification of ICD-9 and is not part of the WHO standard. (3)

The final rule for healthcare facilities to convert from ICD-9-CM to ICD-10-CM and ICD-10-PCS was published in the Federal Register on Friday, January 16, 2009. The effective date of the final rule is March 17, 2009. The rule will update the HIPAA code sets regulation that specifies the use of ICD-9-CM. (1)

Volumes 1 and 2 of ICD-9-CM will be replaced with ICD-10-CM and volume 3 will be replaced with ICD-10-PCS. ICD-10-CM is the United States clinical modification of the ICD-10 WHO standard. ICD-10-PCS was designed specifically in the United States for inpatient procedural coding. (1) As specified in the Federal Register, ICD-10-CM and ICD-10-PCS will be used for reimbursement coding of all inpatient discharges and outpatient encounters on or after October 1, 2013.(2)

Presently Health and Human Services (HHS) estimates the cost of the change to be approximately $1,878.68 million with an estimated benefit of $4,539.63 million over 15 years. HHS has estimated that inpatient coders will require 50 hours of training and outpatient coders will require 10 hours of training.(2)

SNOMED is presently being considered for use to incorporate medical concepts within an electronic health record. SNOMED is too granular for use with reimbursement and possibly with much reporting that is being done. By mapping ICD-10-CM and ICD-10-PCS to SNOMED concepts, we can develop systems that will be able to automate some processes currently being done manually for coding and reimbursement. These two terminologies can work together to provide information needed for the electronic health record.(3) SNOMED can be considered the "front end" terminology and ICD-10 can be the "back end" terminology.

Submitted by Bonnie Altus (February 2009 section)


References:

1. Federal Register, Vol. 74, No. 11, Friday, January 16, 2009.

2. Analysis of the Final Rule: HIPAA Administrative Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS, AHIMA, January 2009.

3. Giannangelo, Kathy, ed. Health Code Sets, Clinical Terminologies, and Classification Systems. Chicago: AHIMA, 2006.