On October 1, 2015, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) will become the standard classification system for all healthcare delivery in the United States, including group health, federal programs (Medicare, Medicaid, Veterans Administration), as well as workers’ compensation.
A new report by the California Workers’ Compensation Institute reviews the history, form and function of the new classification system. There are two main sections of the new classification system:
1. The ICD-10-CM Clinical Modifications; and
2. The ICD-10-PCS Procedure Coding System
It took 21 years for the United States to adopt the ICD-10 system as the national standard, and the upcoming transition will finally allow the antiquated ICD-9 structure to be replaced with the more robust ICD-10 code set, providing greater flexibility into the future.
ICD-9 and ICD-10 codes are primarily intended to describe a patient’s clinical status as accurately as possible, facilitating better communication between medical providers, providers and payers, and government agencies. Medical condition and procedure code sets also enable statistically relevant groupings, which will improve utilization and cost trend analyses. After the initial transition, the more precise and accurate descriptions of a patient’s clinical status captured by the ICD-10-CM/PCS code sets should enhance the quality of the data that is used to track public health conditions, conduct epidemiological research on illnesses and co-morbidities, and assess the types and outcomes of care provided to patients (including the use and effects of new medical technology). The additional detail also should allow more accurate reporting of the nature of injury, which can be used to correlate cause, treatment and outcome, improve clinical decision making and make it easier to identify fraud and abuse.
The CWCI report outlines the similarities and significant differences in the ICD-9 and ICD-10 coding structures. Healthcare providers, payers, claims administrators and other individuals and organizations across the healthcare delivery and support spectrum already have committed significant resources in preparing for the ICD-10 implementation, though ongoing efforts will be required given the scope of the transition. For example, within the California workers’ compensation system alone, the changes in databases, data transfer protocols and business processes will affect medical service providers, medical bill payers, Utilization Review Organizations, Independent Medical Reviewers, Independent Medical Examiners/Qualified Medical Examiners , the state’s workers’ compensation reporting system, Medicare Set-Aside reporting and public policy research databases.
CWCI has published its analysis as a spotlight report, ICD-10’s and the Workers’ Compensation System, which Institute members and subscribers can access in the Research section at http://www.cwci.org/.