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INTRODUCTION

The transition from ICD-9 to ICD-10 and to future ICD revisions is challenging but also provides unique opportunities to improve health care and disease/procedure tracking and data. This transition will better support current technology and health care reform initiatives including the Centers for Medicare & Medicaid Services (CMS) value-based purchasing and pay-for-performance programs; coordinated care models such as accountable care organizations and patient-centered medical homes; the government’s Physician Quality Reporting System; and the move toward adoption of electronic health record systems. In addition, it affords great potential to decrease audit risk since ICD-10 codes allow the physician’s documentation to be translated into a more accurate clinical picture, thereby reducing the chance of misinterpretation by third parties, auditors (eg, recovery audit contractors—RAC), and attorneys.

With improved specificity, ICD-10 codes help health care providers submit highly specific codes for the care they provide, and better reflect severity of illness and support medical necessity. This will hopefully reflect in a physician’s profiling on national registries, consumer health sites, and also with health care entity’s quality reporting.

HISTORY

Classifying illnesses to document disease prevalence and causes of death is not a new concept. The first attempts were made as far back as the 1600s. Initially, it was nothing more than a crude and inconsistent nomenclature with little reliable data. However, during the 1800s, an earnest effort began to create a uniformed system. Medical statisticians were commissioned to embark upon this enormous task. They began their work by using the Bertillion Classification of Causes of Death developed by the French statistician, Jacques Bertillion.

In 1893, the first international classification of diseases (ICD) was adopted by the International Statistical Institute. The United States did not utilize a formal disease classification system until 1898, when the American Public Health Association recommended all of North America adopt this system, and recommended it be updated every 10 years.

Each revision made the ICD more detailed. In 1948, the World Health Organization assumed responsibility for the ICD and published the sixth version, which incorporated morbidity for the first time. At this time, they decided to make ICD the official means of collecting international data for epidemiological surveillance and for health management. The WHO Nomenclature Regulations, adopted in 1967, stipulated that Member States use the most current ICD revision for mortality and morbidity statistics. In 1979, the United States adopted ICD-9, and in 1983 the Inpatient Prospective Payment System in the US required ICD-9 codes to be linked to diagnosis related groups (DRGs) for reimbursement. ICD-9 quickly became antiquated, running out of room for new codes for new diseases and new technology. The 43rd World Health Assembly endorsed ICD-10 in May 1990, however, the United States did not adopt it until October 1, 2015. ICD-10 is dramatically more robust and allows for many more codes than any previous edition, including ICD-9 which has been used in the ...

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