This document discusses the delay in implementation of ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) coding standards in the United States from October 2014 to October 2015. It provides background on ICD coding systems and the changes in ICD-10-CM. The delay provides both relief and challenges - relief through more time to prepare but wasted early investments, while the challenges include needing to refresh trainings before the new implementation date. Next steps discussed are building a knowledgeable local coding workforce and achieving ICD-10-CM compliance among currently certified coders.

1. ICD-10 DELAY:
Relief or Grief?
PETER EDU MD, CPC, CPC-I, CCS
Healthcare Sr. Training Manager
TeleDevelopment Services, Inc.

2. 1. Background
2. What’s new with ICD-10?
3. Impact of ICD-10-CM implementation on
different sectors
4. Causes for ICD-10-CM implementation delay
ICD-10 DELAY: Relief or Grief?
OUTLINE

3. 5. Updates on ICD-10-CM implementation
6. Effects of ICD-10-implementation delay
7. Conclusions and next steps
ICD-10 DELAY: Relief or Grief?
OUTLINE

4. BACKGROUND
What is ICD-10?
• Classification system for diseases and health
problems, created and published by the WHO
• Basis for the compilation of national mortality
and morbidity statistics by WHO member
states
• Also used for reimbursement and resource
allocation by some countries
ICD-10 DELAY: Relief or Grief?

5. BACKGROUND
International versions
• Different countries have their own clinical
modifications for their specific purposes
• Australia, Canada, France, Germany, Korea,
Netherlands, South Africa, Sweden, Thailand,
United States, UAE, etc
• Philippine modification created in 2008
ICD-10 DELAY: Relief or Grief?

6. BACKGROUND
Historical aspects
• WHO members first used ICD-10 in 1994
• New version (ICD-11) is already being
developed, with target completion in 2017
ICD-10 DELAY: Relief or Grief?

7. BACKGROUND
American version
• Used by the Philippine BPO industry
• ICD-9-CM (current), composed of 3 volumes
• Volumes 1 and 2 = diagnosis codes
• Volume 3 = hospital procedure codes
ICD-10 DELAY: Relief or Grief?

8. BACKGROUND
American version
• ICD-10-CM and ICD-10-PCS (new, upcoming)
• ICD-10-CM = diagnosis codes
• ICD-10-PCS = hospital procedure codes
ICD-10 DELAY: Relief or Grief?

9. BACKGROUND
American version: History
• 1978: ICD-9 published by WHO, adopted by
US as ICD-9-CM same year
• 1990: WHO published ICD-10
• 1994: US began development of ICD-10-CM
• 1998: ICD-10-CM first version release
ICD-10 DELAY: Relief or Grief?

10. BACKGROUND
ICD-9-CM Chapters
Chapter 1 Infectious and Parasitic Diseases
Chapter 2 Neoplasms
Chapter 3 Endocrine, Nutritional and Metabolic
Diseases, and Immunity Disorders
Chapter 4 Diseases of Blood and Blood-
Forming Organs
Chapter 5 Mental, Behavioral and
Neurodevelopmental Disorders
Chapter 6 Diseases of Nervous System
and Sense Organs
Chapter 7 Diseases of Circulatory System
Chapter 8 Diseases of Respiratory System
Chapter 9 Diseases of Digestive System
Chapter 10 Diseases of Genitourinary
ICD-10 DELAY: Relief or Grief?
System
Chapter 11 Complications of Pregnancy,
Childbirth, and the Puerperium
Chapter 12 Diseases of Skin and Subcutaneous
Tissue
Chapter 13 Diseases of Musculoskeletal
System and Connective Tissue
Ch 14,15 Congenital Anomalies; Certain
Conditions Originating in Perinatal
Period
Chapter 16 Symptoms, Signs, and Ill-Defined
Conditions
Chapter 17 Injury and Poisoning and E Codes

11. BACKGROUND
ICD-10 DELAY: Relief or Grief?

12. BACKGROUND
Rationale for ICD-10-CM implementation
• Compatibility with global classification
standards (WHO ICD-10)
• Obsolete basis of classification in ICD-9-CM
• Lack of space for new diseases /
pathophysiologic mechanisms in ICD-9-CM
ICD-10 DELAY: Relief or Grief?

13. WHAT’S NEW WITH ICD-10?
ICD-9-CM ICD-10-CM
Structure
(max # of digits)
5 7
Structure
(characters used)
Numbers only Alphanumeric
Specificity ↓ ↑
Number of codes ↓ ↑
ICD-10 DELAY: Relief or Grief?

14. WHAT’S NEW WITH ICD-10?
ICD-9-CM vs ICD-10-CM comparison
• More relevant ambulatory care and encounter
codes
• More specific injury coding
• More combination codes (eg, disease +
symptom description in one code)
ICD-10 DELAY: Relief or Grief?

15. IMPACT OF ICD-10-CM
On healthcare providers
• More conscientious documentation
• Retraining/reorientation of staff
• Investment on software upgrades/updates
• Migration to digital records (EMR)
ICD-10 DELAY: Relief or Grief?

16. IMPACT OF ICD-10-CM
On insurance companies
• Update of entire CMS
• Retraining/reorientation of staff
• Greater need for auditing claims from
providers
• Obamacare is a confounding factor!
ICD-10 DELAY: Relief or Grief?

17. IMPACT OF ICD-10-CM
On HIM service providers
• Retrain certified coders and ensure
compliance to new standards
• Updating of software and/or hardware
• Supply of knowledgeable manpower to cover
for learning curve of existing coders’ retraining
ICD-10 DELAY: Relief or Grief?

18. CAUSES OF I-10 IMPLEMENTATION DELAY
• 12-year gap between I9 and I10 release
(WHO)
• Rapid growth of health records and HIM
technology
• Economic factors
• Logistical nightmare for everyone
ICD-10 DELAY: Relief or Grief?

19. UPDATES ON I-10 IMPLEMENTATION
• Centers for Medicare and Medicaid Services
(CMS) initially announced an October 2014
date, but this was delayed
• Latest FINAL implementation date has been
set to October 1, 2015
ICD-10 DELAY: Relief or Grief?

20. RESULTS OF I-10 DELAY
On healthcare providers
• More time for staff to learn new system
• Preserve status quo for doctors
• Those that already invested will wait another
year to implement new system
• Readiness to adapt to I10 by 10/1/15
ICD-10 DELAY: Relief or Grief?

21. RESULTS OF I-10 DELAY
On payers
• More time to learn new system and grow I10
compliant staff
• Those that already invested will wait another
year to implement new system
• Readiness for dual coding and new rules by
10/1/15
ICD-10 DELAY: Relief or Grief?

22. RESULTS OF I-10 DELAY
On HIM service providers
• More time to learn new system and grow I10
compliant staff
• Those that already invested will wait another
year to implement new system
• Readiness for dual coding and new rules by
10/1/15
• Can better service clients come 10/1/15
ICD-10 DELAY: Relief or Grief?

23. CONCLUSIONS
Relief or grief?
RELIEF GRIEF
• More time to hire and train staff
• More time to setup, test and
ICD-10 DELAY: Relief or Grief?
implement new system
• HIM service providers can better
serve clients for dual coding and
ICD-10-CM requirements in 2015
• Wasted (?) early investment on
ICD-10-CM compliant systems
• Early training of staff may require
refreshers prior to implementation
date

24. NEXT STEPS
Building a knowledgeable workforce from local
healthcare pool
• 50-60,000 new RNs every year
• Availability of US-licensed medical coding instructors
locally
• New AAPC inpatient coding credential in Oct 2014
• Very good outcome of local coder training programs
• High cost of acquiring existing coders in the market
ICD-10 DELAY: Relief or Grief?

25. NEXT STEPS
Achieving ICD-10-CM compliance among currently
certified coders
• Online AAPC and AHIMA exams available for I10
compliance demonstration
• ICD-10-CM and PCS training available from licensed
coding instructors
ICD-10 DELAY: Relief or Grief?

26. ICD-10 DELAY: Relief or Grief?