• This article provides a high level summary of ICD- 10 implementation to
ensure imaging leaders are ready for
this monumental shift in the healthcare
industry. Although it will be challenging, there are a number of compelling
reasons for the change.
• It is important to remember that ICD-
10-CM is not just a software update or
something that only coders have to
worry about. Scheduling and registration staff, clinicians, billing staff, and
edit/denials department will all be
affected. For radiology services, the biggest area impacted is trauma.
• The majority of the implementation
planning will be outside of your control,
but you should get involved where you
can. Identify the items that are unique to
radiology and make your own plan to
ensure they don’t get overlooked. The
first thing to do is select a champion.
EXECUTIVE SUMMARY The International Classification of
Diseases (ICD) is a system for classifying
causes of morbidity (disease) and mortality. The ICD is updated periodically by
the World Health Organization (WHO)
to reflect changes in medical nomenclature, improved understanding of the
causes of disease, and identification of
new diseases. The most recent version is
the 10th edition, known as ICD- 10.
Like many other countries, the
United States uses a customized version of the ICD which was specifically
designed to meet the needs of the US
healthcare system. The system currently in use in the US is ICD-9-CM—a
“Clinical Modification” of the 9th edition of the ICD. ICD-9-CM has been
designated under the Health Insurance Portability and Accountability Act
(HIPAA) as the standard code set for
diagnosis reporting by covered entities.
ICD-9-CM also includes a procedure
classification that is the standard code
set hospitals must use for reporting
In January 2009, the Centers for
Medicare and Medicaid Services (CMS)
announced that the US would switch
over to the 10th edition of the ICD on
October 1, 2013. (Note: CMS is the
agency that administers the Medicare
and Medicaid programs, and it is also
the agency that is responsible under
HIPAA for designating the official coding systems for the US.) However, in
August 2012 CMS issued a Final Rule
that pushed the ICD- 10 implementation
date back to October 1, 2014.
Although ICD- 10 implementation
will be challenging, there are a number of
compelling reasons to make the change.
ICD-9-CM is over 30 years old and was
never designed to meet the needs of a 21st
century healthcare system. Specifically,
• Is running out of space, with limited
ability to accommodate new procedure
and diagnosis codes.
• Uses outdated and inconsistent terminology.
• Lacks the granularity (detailed classification) needed for emerging uses
such as pay-for-performance and bio-surveillance.
• Does not facilitate accurate coverage
decisions by payors.
• Has limited ability to capture new
technology and preventive services.
ICD-10-CM, on the other hand, is
designed to meet all of these needs and has
the flexibility to allow for addition of new
codes as needed. The version of ICD- 10
that will be used in the US has two parts:
ICD-10-CM (Clinical Modification) and
ICD-10-PCS (Procedure Classification
System). ICD-10-CM is a diagnosis coding system that all providers—including
both physicians and hospitals—will use
to report diagnoses. ICD-10-PCS is a
procedure coding system that will be used
only by hospitals for reporting their inpatient procedures. Physician services and
hospital outpatient services/procedures
will continue to be reported using CPT/
HCPCS codes. This article focuses on
the ICD-10-CM diagnosis coding system
By Melody W. Mulaik, MSHS, CPC, CPC-H, RCC, PCS, FCS, CRA, FAHRA
ICD-10: An Opportunity and