Managed Care

ICD-10 Code Change Is Long Overdue

John Marcille

Change isn’t always progress, but in this case, it surely is. The move to ICD-10’s vastly expanded set of disease and procedure codes is necessary because of the many changes in medicine and surgery that have taken place over the decades since the last true overhaul of the ICD code set over 60 years ago!

Yes, it’s about time. Our managing editor, Frank Diamond, in our article, examines many of the difficulties that lie ahead, starting with one that should be resolved very soon: whether the Centers for Medicare and Medicaid Services will stick to the Oct. 1, 2011 implementation date.

Frank discusses the challenges that health plans and payers will face in trying to implement the new ICD-10 codes. It’s a complicated process that will alter the most basic functions health plans perform, says Jim Daley, director of risk and compliance in the information systems department at Blue Cross & Blue Shield of South Carolina. He is a nationally known expert on the subject.

“Health plans look at certain conditions and say they should be treated in a certain way, or this is appropriate or not appropriate for a given condition,” he says. “Those decisions are based, obviously, on the medical condition, but also on the wording and the code associated with it.”

There have been minor changes over the years, but even so, it has been 27 years since the last upgrade to the International Statistical Classification of Diseases and Related Health Problems, and medicine has evolved far beyond ICD-9’s capacity to describe it.

Says Karen Trudel, the deputy director of the Office of E-Health Standards and Services at CMS: “Most parts of the health care industry agree that this needs to be done and that the real discussion is what’s the timing for it and that it’s a major undertaking.”

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