ICD 10 Proves to Be a Major Step Forward in Healthcare Software

ICD 10 or the International Statistical Classification of Diseases and Related Health Problems is a way to code diseases, signs, symptoms, findings, causes of injury and diseases, as classified by the World Health Organization (WHO).

The greatly expanded ICD 10 will replace the ICD 9, which contains only 17000 codes and is considered outdated because of its limited ability to accommodate new procedures and diagnoses. However, the reason why ICD 10 is in news is the new Affordable Care Act that will make it pertinent for technology companies to integrate the ICD 10 coding into the Exchange portal.

The United States will begin official use of ICD-10 on October 1, 2013, using Clinical Modification ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding. All HIPAA "covered entities" must make the change; a pre-requisite to ICD-10 is the adoption of EDI Version 5010 by January 1, 2012. The implementation of ICD-10 has already been delayed. In January 2009, the date was pushed back by two years, to Oct. 1, 2013 rather than a prior proposal of Oct. 1, 2011.

ICD 10 will impact every system, process and transaction that contains or uses a diagnosis code. The changes will have a bearing on a lot of processes including Actuarial Underwriting, Benefits Design, Budgeting and Planning Cycle, Case/Disease Management, Claims, Communications, Customer Service, Enrollment, Finance, Internal Audit/Fraud, IT Systems/Department, Legal/Government Relations/Compliance, LOBs, Provider Contracting, Provider Relations, Reporting, Testing, Training and Vendor Oversight.

ICD10 will help healthcare organizations to keep pace with the several changes that the reforms are bringing in. there are significant alterations in administrative transactions, some of which include requirements for national payer ID, electronics claims attachment and updates to HIPPA transaction every two years.

Centre for Medicare and Medicaid Services will soon conduct a survey to find out about the healthcare industry awareness about ICD 10 and preparedness for transition Version 5010 and ICD 10. The survey will be conducted as soon as CMS receives the approval from the Office of Management and Budget.

On January 16, 2009, the HHS (the Department of Health and Human Services) declared the final regulations in adopting Version 5010 and ICD 10; the two standards of HIPAA transactions. Entities have to first implement Version 5010 before they can implement ICD 10. By January 2011, entities also have to begin meeting interim milestones such as gap analysis, design, development and internal testing.

The aggregated data obtained through the survey will help CMS to improve it outreach program and help educate the healthcare providers, payors, clearinghouses and vendors so that they are able to meet these interim challenges. The education campaign designed by CMS is to support the transition to and adoption of Version 5010 and ICD 10 and will target healthcare professionals who have to take steps to implement the new codes and transaction standards.

Shaun Mike is well known authority on health insurance in the US. He is currently looking to expand his expertise to health insurance and other healthcare software available.