Healthcare Technology Featured Article

October 13, 2015

Understanding ICD-10 and What it Means for Your Healthcare Organization

On October 1 of this year, the healthcare industry underwent a significant transformation when the entire industry began using new diagnostic codes, affecting healthcare records, lab and pathology results, insurance claims and numerous other documents. The new International Classification of Diseases, Version 10 (ICD-10) has 68,000 codes, nearly five times the number of codes in the ICD-9 set that has been used up until this point.

This has significant implications from a data integration standpoint, with multiple different players in the healthcare space dealing with five times as many diagnostic codes. During this period of adjustment, how can organizations ensure as seamless an adoption as possible?

Understanding the basics

The biggest change is that the ICD-10 codes are far more complex than ICD-9. Not only do the codes increase to eight or nine digits from five, but also ICD-10 will be made up of alphanumeric codes, not just the numeric values that made up ICD-9. The new codes cover more diseases in more detail than the codes used in ICD-9, leading to a more intricate network of information that needs to be shared among healthcare providers, insurance companies, pharmacies, etc.

The added complexity of the new codes can lead to exceptions when information is transferred from physicians’ offices to insurance companies. If providers must update their integration systems to handle these new codes in order to ensure their claims reach the insurance companies.

Long term forecast

As with any rollout of new technology, the version of ICD-10 launched on October 1 is only the first iteration, with several updates anticipated as the government notices kinks and bugs in the system that need to be ironed out.

This has implications especially for healthcare providers and insurance companies that have invested in custom code solutions up until this point. These organizations will need technology professionals and engineers able to transition protocols as regulations and standards change. However, as the move to ICD-10 has sweeping organizational implications, business executives who understand the full coding and billing process should play a critical role in overseeing the implementation of the technology.

What’s next

Given the challenges surrounding the implementation of ICD-10, during these first weeks of rollout it will be critical for CIOs to monitor and identify any areas where the full and correct data is not being distributed or accepted properly--before any errors have the chance to snowball.

This is no easy task, especially when exception handling is not automated in an organization’s integration systems. In the absence of automated exception handling, CIOs at healthcare providers will need to manually ensure payments are delivered in the usual timeframe, as late payments can be an early indicator of errors in the system.

As the transition continues, it’s important that affected organizations take the time to understand the new codes, what they mean for their business and how best to seamlessly make the change.

Raman Singh is director of sales engineering at Adeptia, a B2B integration software company that helps its customers achieve faster data on boarding.

Edited by Kyle Piscioniere
By Special Guest
Raman Singh, Director of Sales Engineering, Adeptia ,

FREE eNewsletter

Click here to receive your targeted Healthcare Technology Community eNewsletter.
[Subscribe Now]