ICD-10 implementation and ICD-10 assessments are new to U.S. health system, so many are looking for parallels and lessons learned from other countries.
In a recent blog, we noted that there are many reasons that the U.S. Implementation of ICD-10 will be different. In particular ICD-10 CM is larger than the WHO version of ICD-10, and in the U.S., ICD-10 will serve as a new reimbursement paradigm, unlike Canada. However, as we noted there is one big similarity – more planning is always better.
Here are a few more areas to consider:
In addition to the US ICD-10 CM implementations for diagnosis codes, there is the issue of the procedure side implementation (ICD-10 PCS) supported by CMS in the US.
Second, coders are a critical component and will need extensive training for anatomy and physiology, and the understanding of surgical procedures. The new surgical descriptors will be approximately 87,000 in vs. the ICD-9 of 3,500.
Third ICD-10 includes the cause of the diagnosis.
Fourth, for medical policies, a brief three line rule under ICD-9 to pend, pay or deny a claim may expand to as much as 300 lines in a software system to express the complex business logic.
Several lessons learned in other implementations (Canada, Australia), have included the need for accountability, and well-defined areas of responsibility with sufficient resources. As departments have existing responsibilities it is critical to separate those responsibilities from those required for the ICD-10 implementation, and the project timelines should allow adequate time for sufficient testing.