Getting Ready to Ring the ICD-10 Starting Bell

As the nation’s healthcare community – providers, health plans, and others – continues to await October’s ICD-10 start date, Onpoint is here to help submitters as they prepare to report ICD-10’s more-detailed code sets for our clients’ data collection programs. Since collection specifications vary by client, so does our approach: While some file layouts include a separate ICD version indicator, others (for collections whose layouts have been locked down by legislative and other restrictions) have been adjusted to collect the needed version information within a pre-existing field. (Using the latter approach, this new ICD version indicator, which applies to all ICD diagnosis and procedure codes in a record, is now being collected from our Minnesota and Vermont APCD submitters who are ready for testing.)

For those less familiar with the much-anticipated compliance deadline, the ICD-10 transition is required for any organization covered by the Health Insurance Portability and Accountability Act (HIPAA). While many industrialized nations have already moved from the ICD-9 to the ICD-10 code sets, the United States is finally getting ready to make the shift after postponing last year’s planned October start date. Barring any last-minute change, the official U.S. compliance date is October 1, 2015.

With this transition, the World Health Organization (WHO) – the institution responsible for the code sets’ modification and implementation – is attempting to more precisely define care by capturing clinical details at a much more granular level. Among the important and noteworthy changes:

• The new code set consists of two parts: (1) ICD-10-CM diagnosis coding, which will be used for all U.S. healthcare settings, and (2) ICD-10-PCS inpatient procedure coding, which is reserved for U.S. hospital settings.

• Injuries will be grouped by anatomical location rather than by type of injury.

• Codes corresponding to ICD-9-CM V codes (i.e., factors influencing health status and contact with health services) and E codes (i.e., external causes of injury and poisoning) will be incorporated into the main classification rather than separated into supplementary classifications.

• New code definitions will be provided to reflect modern medical practice (e.g., the definition of acute myocardial infarction – a heart attack – will now be 4 weeks rather than 8 weeks).

• Category restructuring and code reorganization have occurred in a number of ICD-10-CM chapters, resulting in different classifications of certain diseases and disorders.

And, as always, as data submitters prepare to send these new codes to Onpoint, please reach out anytime for assistance or support!