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INTEGRATING ICD-10 IN YOUR PRACTICE
A Strategic Plan for Integrating ICD-10 in Your Practice and
Workflow
Sue Bowman, MJ, RHIA, CCS, FAHIMA, Risë Marie Cleland, BS, and Stuart Staggs, MSIE
OVERVIEW
The adoption of the International Classification of Disease (ICD) 10th Revision (ICD-10) diagnosis code set in the United States has been
legislatively delayed several times with the most recent date for implementation set for October 1, 2015. The transition from ICD-9 to
ICD-10 will be a major undertaking that will require a substantial amount of planning. In the following article, we outline the steps to
develop and implement a strategic plan for the transition to the new code set, identify training needs throughout the practice, and
review the challenges and opportunities associated with the transition to ICD-10.
Unless there is another delay, the United States will transition
from ICD-9 to ICD-10 in all health care settings
on October 1, 2015. This will not be a gradual transition as
there will be no grace period. Still, the replacement of ICD-9
with ICD-10 as the Health Insurance Portability and Accountability
Act (HIPAA)-named code set did not come
without plenty of notice. Before we get into the practical elements
of ICD-10 implementation and the opportunities associated
with the implementation of ICD-10, let us step back
and take a brief look at the history of the ICD.
The fırst international classifıcation edition was adopted in
1893 by the International Statistical Institute and was called
the International List of Causes of Death. The ICD has been
revised over the years and is now the standard diagnostic tool
for epidemiology, health management, and clinical purposes.
It is used globally as the foundation for the identifıcation of
health trends and statistics. 1
The World Health Organization (WHO) has been maintaining
and publishing the ICD since 1948, with periodic revisions.
To date, there have been 10 revisions of the ICD; the
most current edition is ICD-10. The United States has used
ICD to classify the causes of death since 1900 and is currently
using ICD-10 to report causes of death.
In 1979, the WHO adopted ICD-9, and, with the approval
of WHO, the United States adopted a modifıed version of
ICD-9, the International Classifıcation of Diseases Clinical
Modifıcation (ICD-9-CM), to assign codes to diagnoses associated
with inpatient, outpatient, and physician offıce utilization,
and the International Classifıcation of Diseases
Procedure Coding System (ICD-9-PCS) to assign codes associated
with inpatient procedures. 2
WHO adopted ICD-10 in 1994, and, once again, the
United States received approval from WHO, which owns and
publishes the classifıcation, to develop a revised ICD-10-CM
for use in this country. However, although the developed
ICD-10-CM codes are updated annually, we have yet to
adopt them.
The U.S. Department of Health and Human Services fırst
published a proposed rule to replace ICD-9-CM with ICD-
10-CM in August 2008. At that time, it proposed an effective
date of October 1, 2011, for the transition to ICD-10. Since then,
the ICD-10 deadline has been postponed three times (Fig. 1).
The American Medical Association (AMA) has been very
vocal in their opposition to the adoption of ICD-10. Still, in a
letter to the Centers for Medicare & Medicaid Services (CMS)
just before the most recent delay, the AMA acknowledged
that there were other “well-intended” stakeholders in the
health care industry that are advocating the move to ICD-10.
In their letter, the AMA asked CMS to implement the following
provisions if they were intent on adopting ICD-10:
1. A 2-year implementation period during which Medicare
will not deny payment based on the specifıcity of
the ICD-10 code, will provide feedback to the physician
on any coding concerns, and will not recoup payment
because of a lack of ICD-10 specifıcity.
2. When the most specifıc ICD-10 code is submitted no
additional information will be required to adjudicate
the claim, particularly in the absence of an attachment
standard.
3. Physicians would be eligible for advance payments
when the physician has submitted claims but is having
problems getting the claim to reach the contractor because
of problems on the contractor’s end; a physician
From the American Health Information Management Association, Chicago, IL; Washington State Medical Oncology Society and Oplinc, Inc., Vancouver, WA; McKesson Specialty Health, The
Woodlands, TX.
Disclosures of potential conflicts of interest are found at the end of this article.
Corresponding author: Risë Marie Cleland, BS, Oplinc, Inc., 300 W. 8th St., Unit 419, Vancouver, WA 98660; email: rise@wsmos.org.
© 2015 by American Society of Clinical Oncology.
asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK
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