ICD-10 overview: What DCs need to know

By Dava Stewart

The 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) was officially adopted by the 43rd World Health Assembly in 1990. On March 31, 2014, the United States congress voted to delay the implementation of ICD-10 for the second time. The original deadline was Oct. 1, 2013; the current deadline is Oct. 1, 2015.

The most recent delay left health information management specialists in the lurch, satisfied physicians’ groups, and gave small practices — like many chiropractic offices — a little more time to prepare. You may be wondering exactly what the major differences between ICD-9 and ICD-10 are, and how DCs and their staffs can be ready for the switch when it does happen.

According to the World Health Organization (WHO), the ICD is used to:

“classify diseases and other health problems recorded on many types of health and vital records including death certificates and health records. In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. It is used for reimbursement and resource allocation decision-making by countries.”

The use of the ICD is important for many, varied reasons, but at a basic, personal level for DCs, the ICD determines how conditions and illnesses are coded by care providers and submitted to receive reimbursement from insurance companies. The biggest reason that ICD-9 was revised is that it does not reflect advances in medical technology and does not allow for code sets to be expanded. ICD-10 allows for expanded code sets and also allows for greater detail of diagnoses. It reflects the fact that medical technology is ever-advancing, as well.

Hopefully, by this point, all chiropractic practices have begun preparing for the transition to ICD-10. Without adequate preparation, the switch will be disruptive. Any claims reported after Oct. 1, 2015, will be rejected as non-compliant, which means that payment for services will be delayed or outright denied. Since most DCs operate practices to make a living, denied payments are unacceptable.

The American Chiropractic Association offers several resources to help chiropractic practices prepare for the transition. There are classes, websites, and even whole companies dedicated to helping DCs and their staffs get into a good position to transition to ICD with as little disruption as possible.

The Centers for Medicare and Medicaid Services (CMS) provides a number of tools to help providers prepare for the transition to ICD-10, as well. The Road to 10 for “other specialties” includes several references that can help DCs build specific, individualized action plans. The CMS plans to test ICD-10 in November 2014, and again in May and June 2015.

Wherever your practice is in preparing for the transition from ICD-9 to ICD-10, using the next year to continue testing and preparing will help keep your practice — and your bottom line — healthy. More preparation will result in less stress, which often means you are able to provide a higher level of care for your patients.