Medical Billers Transitioning to Mammoth ICD-10 Classification System

American medical coders are continuing to familiarize themselves with the medical code compendium ICD-10, the 1,100-page most recent version of the International Statistical Classification of Diseases and Related Health Problems, according to Sarah Kliff in the Washington Post’s Wonkblog.

Published by the World Health Organization, the ICD is used worldwide as an exhaustive listing of diseases, symptoms, medical procedures, mortality statistics, and external causes of injury, illness and death. Organized by anatomy, the ICD’s codes are used by insurers to identify specific ailments, injuries, and causes of death in order to determine how much to reimburse hospitals for care. The codes also determine how Medicare and most private health insurers assess a value for each patient visit.

This tenth edition system has 68,000 codes—more than four times as many as its predecessor, ICD-9—and more specifically identifies diseases, death and their causes. According to Kliff, two key factors are behind the expansion: the ICD-10 differentiates between left and right sides of the body, which can help identify fraud; and, the new codes categorize whether a trip to the hospital was for initial or subsequent treatment, which is important for reimbursement purposes because first visits to the doctor tend to require more resources.

Transitioning to ICD-10’s expanded classification system has been controversial. Supporters maintain that adding specificity to medical diagnoses will make it easier for insurers to root out fraudulent claims and allow public health researchers to catch warning signs of a pandemic. Hospitals and insurers, on the other hand, contend that it has already cost them billions of dollars in upgrading technology and training medical coders on the revisions. They call it a massive and costly regulatory burden that won’t improve patient care but will make it more difficult and time-consuming, at least initially, for many medical billers to find the correct code for a specific ailment or cause of death when codes are broken down in such granular detail.

The AMA in a letter earlier this month to Health and Human Services Secretary Kathleen Sebelius stated, “Adopting ICD-10, while it may provide benefits to others in the health-care system, is unlikely to improve the care physicians provide their patients and takes valuable resources away from implementing delivery reforms and health information technology.” Wonkblog cites a study funded by the American Medical Association estimated that it could cost doctors’ offices $56,000 to $8 million to transition to ICD-10, depending on the size of the practice.

Although adoption of the new code has been delayed twice since its initial target date of 2008, the federal government has a go-live date of Oct. 1, 2014 for ICD-10. Stay tuned.