Preparing Health Information Management for Transition to
In its current practice, health information management (HIM) in most medical institutions
in the U.S. relies on the IDC-9 (International Classification of Diseases, Ninth Revision)
for coding and reporting medical diagnoses and inpatient procedures. However, new
developments in medical technology and knowledge have rendered IDC-9 inadequate in
providing an accurate representation of current medical practices
There are significant differences between ICD-9 and ICD-10. For instance, ICD-9-CM
(Clinical Modification) diagnosis codes only number to over 14,000, while ICD-10 has a
total of 68,000 codes. Additionally, the length of the characters in ICD-9-CM is 3 to 5
digits long, while ICD-10-CM is 3 to 7. The procedure code system (PCS) for both also
differs. In ICD-9, the codes are 3 to 4 in length and numbers to about 4,000. In contrast,
ICD-10-PCS is 7 characters long and numbers approximately 87,000.
The increased number of codes and changes in the character length of each code reflects the
need to increase code specificity and flexibility to accurately describe new technologies,
treatment methods, and terminologies used today. The limitations of ICD-9 make it
difficult for coders to select the most applicable code to document a disease, symptom,
condition, circumstance, specific body part, and service provided. In consequence, payers
may not be able to fairly reimburse claims for treatments patients have received.
With ICD-10 set for implementation in the U.S., healthcare institutions must make
adequate preparations for the transition to remain compliant with the new standard. Failure
to make the change by the deadline can result in the rejection of the codes used in
transactions for non-compliance.
Making the transition, however, is not that simple. ICD-10 is more complex than ICD-9
due to the length and sheer number of the codes. Educating the staff on the structure and
benefits of the new system would necessarily disrupt normal operations. Those who need
retraining include the institution's HIM staff, accounting professionals, corporate
compliance staff, auditors, and data quality management staff, among many others.
The required hours for intense coding training are estimated based on the ICD-10-CM Field
Testing Project of the American Hospital Association/American Health Information
Management Association (AHA/AHIMA). Experienced coding professionals may require a
maximum of 16 hours of training in ICD-10-CM, while physicians may need much less due
to the fewer codes they may use. As for ICD-10-PCS, an estimated 16 to 24 hours
additional training may be required. Participants in the study also believe that training
should be provided 3 to 6 months prior to the implementation of ICD-10-CM.
Internal testing is also necessary to ensure that transactions generated are compliant with
ICD-10. An institution's clearinghouses, billing companies, and payers will also have to
upgrade to ICD-10. External testing will then have to be performed to ensure that they are
able to send and receive transactions using ICD-10 codes.
Given the challenges of transitioning to ICD-10, healthcare organizations will require the
assistance of a firm that specializes in health information managementparticularly in coding
and auditing. Such firms can help medical institutions transition to the new system by
providing resources that cover training, improve existing coding accuracy, and identify
areas of improvement.
In case institutions are short on HIM professionals who can supervise the upgrade, experts
from these firms can serve as interim health information managers. In this position, they
can identify staff that need training in ICD-10, oversee the operations and processes done
during the transition, and ensure that Information Systems used by the institution are ready
to accommodate changes.
Woodham & Associates offer healthcare organizations services to help them prepare for
ICD-10 adoption. To learn more medical coding company, visit Woodhamhim or call 1866-WOODHAM (966-3426).