Ready or not! Here comes ICD-10.

Area of Science:

• Health Informatics
• Medical Coding Systems
• Healthcare Administration

Background:

• The Health Insurance Portability and Accountability Act (HIPAA) mandated the use of ICD-9 for electronic health transactions.
• A federal regulation requires the replacement of ICD-9 with ICD-10, effective October 1, 2013.

Purpose of the Study:

• To analyze the transition from the International Classification of Diseases-9 (ICD-9) to the International Classification of Diseases-10 (ICD-10) coding system.
• To highlight the significant increase in code complexity and associated costs and risks.

Main Methods:

• Comparative analysis of ICD-9 and ICD-10 code structures and volumes.
• Review of regulatory mandates and projected financial impacts.

Main Results:

• ICD-10 contains over 141,000 codes, a 712% increase from ICD-9's <20,000 codes.
• Complex mapping exists between ICD-9 and ICD-10, with single ICD-9 codes mapping to over 50 ICD-10 codes.
• Estimated physician costs range from $25,000 to $50,000 per provider.

Conclusions:

• The transition to ICD-10 represents a substantial increase in complexity, cost, and risk for healthcare payers and providers.
• While proponents cite potential healthcare quality improvements due to enhanced granularity, detractors emphasize the burdensome nature of the new system.