ICD-10 and the future of the coding profession The ICD-9 system has been in use in the United States since 1979. The original intent was to update it every 10 years. However, these updates never occurred and a major revision is long overdue. ICD-9-CM is based on the World Health Organization’s ICD-9 system. In the United States, the National Center for Health Statistics and the Centers for Medicare & Medicaid Services maintain the ICD-9-CM codes.

 

Effective October 1, 2015, ICD-10 will replace ICD-9 in the United States. ICD-10-CM will replace ICD-9-CM diagnosis codes (Volumes 1 and 2) in inpatient, outpatient, and professional services settings. ICD-10-PCS will replace ICD-9-CM procedure codes (Volume 3) used primarily for inpatient facility services. HCPCS, including CPT and HCPCS Level II, will remain in use for procedure coding in outpatient and physician settings.

 

Codes use codes to indicate how, why, and where a patient was seen for healthcare. The current ICD-9-CM system allows limited capture of this information, but more specificity is imperative to capture specificity in relation to diagnoses and also to measure outcomes for procedures used to treat such conditions. ICD-10-CM and ICD-10-PCS will allow increased specificity and room for expansion. ICD-9-CM does not allow for such growth, which limits its ability to remain a viable system. The United States also needs to be able to exchange clinical data with other nations. Most, including Canada, already use ICD-10.

 

Anticipated benefits of ICD-10-CM and ICD-10-PCS include:

• More accurate payments for new procedures
• A better understanding of new procedures
• A better understanding of the value of new procedures
• Improved disease management
• Standardization of disease monitoring and reporting internationally
• Fewer miscoded, rejected, and improper reimbursement claims
• A better understanding of health outcomes

The transition to ICD-10 will mean existing and new coders will need to learn the new coding system. Training for most will likely begin in earnest at the end of 2011 and throughout 2012 but industry experts suggest that coders start gaining a stronger knowledge of anatomy and physiology now. Inpatient coders will need in-depth knowledge of medical terminology to understand the different approaches and root operations that are fundamental to ICD-10-PCS.

 

Certified coders will also need to show their proficiency in the new coding system. For holders of an AAPC credential, all certified coders will need to take an ICD-10 proficiency exam that the organization will start offering in October 2012. Coders will need to complete the online, timed, open book test by September 30, 2014. The AAPC will require its certified coders to pass this test to retain their certification.