Implemented in 1979, ICD-9 enjoyed a 36 year reign in the U.S. before being phased out.  Service providers first exposed to ICD-10 and DSM-5 with the October 2015 transition are understandably frustrated with having to move to an entirely new set of diagnosis and procedure codes; there are about nine times the number of codes with ICD-10 versus its predecessor due to ICD-10’s expanded definitions.

And while the majority of system conversions were completed with ample preparation and training for those responsible to assign the new codes, the problems experienced by others are not unique.

CPT and HCPS codes were not affected by the implementation, but the new ICD codes themselves are longer than their predecessors – seven characters versus five.  As a result, all integrated systems (those which talk with one another) need to modified together to test the updated file layouts incorporating the new codes.  Wherever provider service data needs to go through multiple systems prior to payer submission, a coordinated testing effort is required to ensure all systems behave the same way.  Validation scripts, or the computer system code responsible for ensuring valid IDC-10 codes have been entered correctly into any system, need to be consistent across all systems for records submissions.  System vendor readiness has become increasingly important as providers have transitioned to updated coding requirements.

Initial data entry of the new codes has been challenging, particularly for specific provider service areas such as mental health and behavioral health which have seen a substantial degree of increase in diagnosis and procedure codes.  Some new codes are combined for Mental and Behavioral Health.  Opioid Dependence is now more finely classified as Opioid Dependence with withdrawal, for example versus simply Opioid Dependence.  Add to this an understanding that the divide between mental health and physical health is narrowing from two classification systems, the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders, selection of the correct code can be challenging.

The overall time crunch experienced by everyone moving to ICD-10 can be alleviated by successful planning, early training and education, coordinated testing and early system vendor compliance, all of which will be good practice and procedure for ICD-11, now targeted for 2018.