ICD-10: Benefits and Challenges Essay

Summary

The International Statistical Classification of Diseases and Related Health Problems (known as ICD) is a significant issue in the healthcare system maintained by the World Health Organization to provide a clear guide on how to make a correct diagnosis and manage healthcare properly. There are several versions of the classification developed in different periods. The current paper aims at discussing the benefits and challenges of the transition from ICD-9 to ICD-10 and explaining the main characteristics of ICD-10 in regards to hospitals, payers, and staff.

Benefits of ICD-10 over ICD-9

People get access to a more expansive and detailed system within the frames of which such activities like coding, billing, or reimbursing became possible. ICD-10 has a number of benefits over its predecessor. Manchikanti, Falco, and Hirsch (2013) say that ICD-10, as a medical classification with certain disease codes, the description of signs and symptoms, and patient complaints, affects payers and providers considerably and “is expected to exceed both the Health Insurance Portability and Accountability Act (HIPAA) and Y2K in terms of costs and risks” (p. 86). In comparison with ICD-9, ICD-10 has an easier way of comparing mortality and morbidity facts and improved quality of information about diseases (Centers for Disease Control and Prevention, 2015). The facts about disease severity, the complexity of conditions, and laterality are available. The sections about pregnancy and postoperative periods are considerably improved as well. ICD-10 has 69,000 codes with a detailed description of a disease compared to ICD-9 with its 14,000 codes with some brief facts about a particular disease.

ICD-10 Potential and Real Challenges

ICD-10 is also characterized by challenges for hospitals, staff, and payers. These real and potential problems should be identified as soon as possible to overcome serious troubles in the future. The changes in the healthcare infrastructure are based on the necessity to re-evaluate clinical documentation and the processes of insurance claims. Hospitals may face management challenges like the necessity to inform people about the innovations, spend certain time on learning the system, and meet the deadlines set by CMS. More detailed descriptions lead to different diagnoses and classifications of diseases. The staff has to learn the innovations within a short period of time. This switch to ICD-10 requires more organizational changes. The process of ICD-10 mapping is the main challenge for the payers, who prefer to use GEMs. Payers have to add or delete several codes to get non-problematic access to the new coding system.

Hospital Activities for October 2015 Implementation

To get ready for October 2015, the date of an implementation of a new ICD-10, many hospitals try to take certain steps and learn better the possible challenges and misunderstandings that can take place. The major activities of hospitals are as follows:

1. Software upgrading;
2. The evaluation of clinical documentation;
3. The analysis of the already known nuances of the new system;
4. Certain financial preparations;
5. Readiness for a hospital’s cash flow being disrupted for some period of time;
6. Medical staff’s access to the information about the diseases;
7. The creation of a plan according to which the staff is trained and the working processes are updated;
8. Training of the employees on how to choose the most crucial facts from the information that is offered by an ICD-10 code;
9. Open communication with all stakeholders;
10. Preliminary tests of the system in regards to the known ICT-10 characteristics.

The identification of all challenges is impossible as some of them may appear in the process of implementation. Still, the two most important steps, the identification of the challenges and their introduction to healthcare providers and payers, have been already taken. As it is said, forewarned is forearmed.

Interactions between ICD-10 and SNOMED

Many researchers admit that SNOMED (one of the most comprehensive and detailed healthcare terminologies in the whole world) can be rather helpful in the process of transition to ICD-10 (Sollie, Sijmons, Lindhout, Ploeg, Gozalbo, Veheijen, & Waterham, 2013). ICD-10 and SNOMED are the systems that differ considerably, but they can work together. Their cooperation leads to a number of benefits for healthcare providers. SNOMED is the terminology system that can support the ICD-10 implementation as it can perform a function of a common language for ICD-9 and ICD-10. SNOMED’s ability to be used in research and clinical settings provides people with a chance to ICD-10 under the same conditions. Some healthcare providers are not able to use ICD-10 directly; therefore, they can combine the information available at SNOMED and the information offered by ICD-10. In addition, ICD-10 is full of “unfriendly” terms, and SNOMED can help to find the necessary explanations. Finally, the success of the interaction between SNOMED and ICD-10 is supported by the flexibility of data retrieval. Not many existing systems can offer this opportunity.

In general, the evaluation of ICD-10, its connection with SNOMED, and its comparison with ICD-9 help to realize that the offered system is one more step to improve the current healthcare system and provide people with a chance to have constant access to the medical theoretical background even in spite of the existing challenges and problems.

References

“International classification of diseases, (ICD-10-CM/PCS) transition.” (2015). Centers for Disease Control and Prevention. Web.

Manchikanti, L., Falco, F.J., & Hirsch, J.A. (2013). Ready or not! Here comes ICD-10. Journal of NeuroInterventional Surgery, 5(6), 86-91.

Sollie, A., Sijmons, R.H., Lindhout, D., Ploeg, A.T., Gozalbo, M.E.R., Veheijen, S.F., & Waterham, H.R. (2013). A new coding system for metabolic disorders demonstrates gaps in the international disease classifications ICD-10 and SNOMED-CT, which can be a barrier to genotype-phenotype data sharing. Human Mutation, 34(7), 967-973.