The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition/situation can be assigned to a unique category and given a code. The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics, reimbursement systems and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO Family of International Classifications (WHO-FIC). The ICD is revised periodically and is currently in its tenth edition in most of the nations except a few like United States which still is continuing to use the previous edition, i.e., ICD-9.

The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition/situation can be assigned to a unique category and given a code. The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics, reimbursement systems and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO Family of International Classifications (WHO-FIC). The ICD is revised periodically and is currently in its tenth edition in most of the nations except a few like United States which still is continuing to use the previous edition, i.e., ICD-9.

The department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets medical coders and billers in the United States use now to report healthcare diagnoses and procedures with ICD-10 code sets, effective October 1, 2013. Incorporation of ICD-10 codes is the biggest change in standard healthcare coding systems in decades which will not only drastically increase but also change the structure of the codes that providers and payers have been using for the past three decades. Before that, on January 1, 2012, standards for electronic health transactions change from Version 4010/4010A1 to Version 5010. Unlike Version 4010, Version 5010 accommodates the ICD-10 code structure. This change before the ICD-10 implementation date helps in adequate testing and implementation time. Along with its transaction precursor Version 5010, ICD-10 implementation will impact every system, process and transaction that contains or uses a diagnosis code.

No wonder, this is often but correctly compared to the effort and planning that took place around Y2K.

ICD-10–CM: The diagnosis classification systems developed by the Centers for Disease control & prevention for use in US healthcare treatment settings. Diagnosis coding under this system uses three to seven alpha and numeric digits and full code titles, but the format is very much the same as ICD-9 CM

ICD-10-PCS: The procedure classification system developed by the Centers for Medicare and Medicaid system (CMS) for use in the US for inpatient hospital settings only. The new procedure coding system uses seven alpha or numeric digits compared to three or four numeric digits that the previous edition used.

The new coding system provides significant improvements through greater detailed information and the ability to expand in order to capture additional advancement in clinical medicine. Below explains the benefits of transitioning to ICD-10.

The transition to ICD-10 will affect every segment of the US healthcare industry. From providers to payers, the transition includes the replacement of existing systems to support ICD-10, retraining the entire medical support work force, and incorporating strategies to avoid errors and insure success.

Coding Professionals: The new classification system does retain the traditional format and many of the same characteristics and conventions and thus, should not be too difficult for experienced coders to achieve coding proficiency. An additional problem that could be encountered is a shortage of credentialed, professional coders. Currently, there is a shortage of coders skilled in both ICD-9-CM and CPT coding, and some coders may opt to retire before learning an entirely new system thus exacerbating the problem. Labor statistics predict a shortage of trained coders in the next several years.

Payers: Payers need to modify or upgrade all systems that currently use the ICD-9 set, and provide training on ICD-10 coding classification to all members. Due to dual coding systems, the work load will increase considerably which could lead to a delay in reimbursement and an increase in the backlog of claims. Additional staff members will be required for claims adjudication, claims auditing and fraud detection.

Providers: Although providers must also implement the same ICD-10 code sets as payers, the challenges faced by providers are much different than those faced by payers. For providers, this compliance effort introduces ICD-10 into the clinical process. With the increased specificity in ICD-10-CM, this issue will continue to be an essential element in the collection of good statistical data as well as the key to appropriate reimbursement. Among the primary challenges, are training needs, vendors, clearing house and health plan contracts, billing form revision or replacement and data requirements will need be to reviewed and amended.

1. Identify your current systems and work processes that use ICD-9 codes
2. Talk with your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes
3. Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition
4. Talk with your payers about how ICD-10 implementation might affect your contracts
5. Identify potential changes to work flow and business processes
6. Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes
7. Budget for time and costs related to ICD-10 implementation
8. Conduct test transactions using Version 5010/ICD-10 codes with your payers and clearinghouses
9. Factor in any abnormal cash flow disparity post implementation from a contingent situation

1. Incorporate a team to handle ICD-10 implementation
2. Start an intranet resource for ICD-10 implementation team to share/update information
3. Assess and identify processes/systems using ICD-9-CM
4. Allocate adequate financial and human resources for smooth transition to ICD-10
5. Provision a system to look up archived ICD-9-CM data post ICD-10 implementation
6. Assess staff training needs and provide them with adequate online training, as to minimize their absence from work while at training
7. Prepare for implement of Version 5010, the transaction precursor of ICD-10
8. Review vendor readiness and assess their game plans for smooth ICD-10 implementation
9. Conduct adequate test transactions using Version 5010/ICD-10 codes

The below are the mandatory guidelines issued by HHS.