Practice Update
ICD-10: Ready or Not!
fter two one-year reprieves, it’s finally here: The
International Classification of Diseases, 10th
Revision, Clinical Modification (ICD-10-CM).
Nationwide, on October 1, 2015, all
health-care business transactions in the
United States converted to ICD-10 from the previous version of the ICD (ICD-9). If they did not convert, claims
and electronic transactions will be rejected. The ICD-9
coding system has been used in the United States since
1979, meaning for most people working in health care, it
is the only diagnostic coding system they have known.
The Long Road to ICD-10 Implementation
According to Daniel B. Martin, MD, from the University
of Washington School of Medicine and Seattle Cancer
Care Alliance, the main problem with ICD-9 is its age. Not
only does ICD-9 fail to reflect progress in both disease and
diagnostic knowledge, said Dr. Martin, but its practically
ancient 1979 format does not lend itself to upgrades.1
Work on ICD-10 began in 1983, just four years after
ICD-9 went into effect, and was completed in 1992. Most
countries have already transitioned to ICD-10 (Canada,
for instance, completed its five-year changeover in 2005).
ICD-10 is expected to improve “tracking of diagnosis
trends, public health needs, and epidemic outbreaks,” Dr.
Martin said, “and will enable more accurate payments
for new procedures; reduce miscoded, rejected, and
improper reimbursement claims; and provide a better
understanding of the value of new procedures.”
All of this will lead, presumably, to systemic costsavings, but the road to those savings is a costly one. To
prepare for implementation, organizations have had to
devote significant resources to information-technology
upgrades, training, and payer contract renegotiations.
Lost productivity also adds to the total expense: One Canadian hospital reported that the changeover to ICD-10
slowed overall productivity for more than a year.2
How Will the Conversion Affect
Hematologists?
The greatest challenge to implementation of ICD-10
has been the changes in diagnostic code reporting from
ICD-9. For instance:
• The total number of ICD-9 diagnostic codes is about
13,000. ICD-10 has about 68,000.
• The ICD-10 code set has been expanded from five
positions (first one alphanumeric, others numeric) to
seven positions. The codes use alphanumeric characters
in all positions, not just the first position as in ICD-9.
• There is no clear mapping between ICD-9-CM and
ICD-10-CM code sets. There are some one-to-