Countdown to ICD-10 Winds Down as October 1 Start Date Approaches

by Kimberly J. Retzlaff •

It may feel as though we have been perpetually counting down to ICD-10—the International Classification of Diseases, Tenth Revision—but the clock is finally running out. After the initial 2009 decision to switch and two year-long delays, Oct. 1, 2015 now marks the official “go live” date for the significantly revised and expanded coding language. By the time this issue of ENTtoday goes to press, the clock will read less than 30 days.

As with any major process change, ICD-10 comes with both benefits and challenges. On the plus side, it carries the potential for increased international collaboration, the collection of more detailed health data, and more precise documentation of the patient experience. Ultimately, this should lead to better analysis of disease and its progression, facilitate better quality of care, and improve treatment outcomes. It’s also expected to contribute to epidemiological research and population health management.

“One of the greatest benefits of ICD-10 is that there are improved descriptions of patient illnesses,” said James C. Denneny III, MD, executive vice president and CEO of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) and the AAO-HNS Foundation (AAO-HNSF). “Better descriptions mean better data to help physicians treat patients more effectively. ICD-10 codes extend beyond the classification of diseases and injuries to include risk factors, too. The codes have been updated for the clinical practices of today, and the structure of ICD-10 allows for greater expansion of codes in the future.”

The most significant difference [between ICD-9 and ICD-10] is the code structure: ICD-9 codes contain three to five characters, while ICD-10 codes contain up to seven alphanumeric characters. Furthermore, the “V” and “E” codes from ICD-9 are being discontinued, and the sixth digit in ICD-10 will mainly be numeric and will identify laterality and drug poisoning.

On the flip side, the challenges inherent in the switch include the significantly increased scope, technical difficulties, training needs, and financial risks, and these issues are projected to be unevenly experienced by physicians who work in hospital systems, multispecialty groups, and smaller private practices. An additional complication is the potential for varying levels of specificity required by CMS compared with third-party payers as a result of the 12-month implementation period that was announced in July. Despite the varying level of complications, one truth is clear: The switch is not optional, and now is the time to make sure everything’s in place when the clock runs out in October.

The Current View

ICD-10 codes must be used on all HIPAA transactions, including both outpatient claims with dates of service and inpatient claims with dates of discharge of Oct. 1, 2015, and beyond. Claims and other transactions with outdated codes may be rejected and need to be resubmitted, which could result in delays and affect reimbursements.