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ICD-10: from transition to full implementation—and the first round of updates

The transition from ICD-9 to ICD-10, which took effect October 1, 2015, has significantly impacted health care providers. An entirely new set of codes as well as expansion of codes for greater specificity are now required.

ICD-10 is a completely different system. The code set has been expanded from five positions (first one alphanumeric, others numeric) to seven positions. The codes use alphanumeric characters in all positions, not just the first position as in ICD-9. As of the latest version, there are 68,000 existing codes, as opposed to the 13,000 in ICD-9.

It’s not surprising that the shift to the new system initially met with trepidation. Indeed, it was delayed three times out of concern about the ability to meet the requirements.

Nevertheless, the United States is now one of more than 100 countries that use ICD-10.

Today’s coding climate

In order to better understand the impact of ICD-10 on U.S. health care providers, post implementation, Medical Office Manager asked Judy Monestime, DBA, RHIA, CDIP, CPC, CPC-I, AHIMA approved ICD-10-CM/PCS trainer, for her perspective.

“The go-live of ICD-10 came and went without the scores of rejected claims, financial losses, mass physician retirements or coding disruption that some in the health care industry forecasted,” Monestime says. “Many attributed this to the education and training efforts of providers. CMS [Centers for Medicare & Medicaid Services] also reported that the transition to ICD-10 had been successful with very little disruption.”

What’s more, there doesn’t seem to have been the steep learning curve that was predicted. According to CMS, one month after implementation, only 2 percent of all claims submitted were rejected due to incomplete or invalid information, while only .09 percent of claims were rejected due to invalid ICD-10 codes.


Experts also expected a sharp decline in productivity. Yet this doesn’t appear to be the case, either.

Monestime cites post-implementation productivity survey data from the American Health Information Management Association (AHIMA): “Overall, respondents noted they experienced a 14.15 percent decrease in productivity, yet only a 0.65 percent decrease in accuracy. Of those who responded, 67.9 percent noted a decrease in productivity, 5.8 percent noted an increase in productivity, and 26.3 percent noted no change in productivity. In terms of accuracy, only 26.9 percent saw a decrease in accuracy, 11.5 percent an increase in accuracy, and 61.5 percent no change in accuracy.”

But Monestime points out that these survey results, which were released in June 2016, only provide a window into the new coding environment.

“Some argue that this is not a representation of the actual productivity of ICD-10 coding,” she says. “I am sure that more research will be conducted.”   

Current challenges

With regard to specific challenges, H.I.M. ON CALL, a provider of health information and coding solutions, has identified the following coding areas with which it has seen coding professionals struggle:

  1. External causes of morbidity (V00-Y99)
  2. Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
  3. Injury, poisoning, and certain other consequences of external causes (S00-T88)
  4. Congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  5. Diseases of the blood and blood-forming organs, and certain disorders involving the immune mechanism (D50-D89)

“Providers should keep an eye out for education opportunities through their professional organization to improve on those areas,” says Monestime.

Meanwhile, they should pay attention to the calendar.

“It is also important to note that the Medicare’s 12-month grace period for auditing ICD-10 codes will expire soon,” Monestime says. “It is imperative that coding be performed to the highest level of specificity to avoid financial and operational disruption.”

New challenges

If this weren’t enough, CMS has released ICD-10 2017 updates, which take effect October 1, 2016. There are 1,943 new codes and 422 revisions.

Still, these changes may not be as daunting as the numbers suggest.

“While this is the first annual update in five years for ICD-10-CM, medical providers should not panic. Coders are used to annual coding updates in the ICD-9 system,” Monestime says.

And not all changes apply to every medical office.

“Remember, no provider uses every single ICD-10 code. Focus on the code changes that represent the medical practice’s patient population,” she says.

Ongoing challenges

For medical practices still struggling to adapt to the new codes, Monestime offers additional advice.

“The first thing to do is to assess the root cause,” she says. “Is it clinical documentation, coding or technology (EHR)?

“The good news is there are resources in our industry to assist, including In the event more assistance is needed, providers should seek help from consultants to ensure that the issues are addressed and mitigated.”

Editor’s picks:

Reasons for health services encounter get codes in Chapter 21 of ICD-10

Frequently coded conditions in Chapter 4 of ICD-10 CM

Eye diseases get their own new coding section under ICD-10









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