1. Increased number of codes and specificity:

  • 125,000 new diagnosis and procedure codes
  • Requires a high level of coder expertise in the areas of anatomy, physiology, pathophysiology and medical terminology

2. ICD-10 has tens of thousands of more terms than ICD-9-CM. To use ICD-10 effectively coders must know:

  • Greek and Latin prefixes, suffixes, roots and combining forms used as the basis of most medical terms
  • Commonly accepted and approved medical abbreviations
  • Eponyms and names of syndromes
  • Alternative names and descriptions for diseases
  • Adjectives used to describe and define diseases and disorders (purulent, necrotic, etc.)
  • Verbs and terms used to describe surgical approaches and techniques (resect, dissect, incise, excise, aspirate, -scopic, -otomy, -ectomy, etc.)
  • Technology driven and manufacturer given names for tests, devices and procedures

3. The change to ICD-10 impacted all departments:

  • Requires a multi-disciplinary approach

4. Enormous healthcare-wide impact

  • ICD-10 is used by all providers, all health plans and all payers
  • Technology requires coding input

5. ICD-10 was the first FULL replacement in 30 years

6. Complicated Mapping

  • No one-to-one mapping from ICD-9 to ICD-10
  • There may be multiple one-to-one possibilities
  • There may be multiple cluster possibilities, with each ICD-10-PCS code a complete procedure while ICD-9 may be a combination of codes

7. Anticipated short-term consequences of implementation

  • Coding productivity estimated to decline by 10% – 15%
  • Declining reimbursements and increased days in A/R (quantify?)
  • Increased claims denials

8. Anticipated Long-Term Benefits

  • Improved analytics based on increased specificity
  • More accurate reimbursements

9. Extensive foundational knowledge is necessary:

  • Medical record fundamentals
  • Coding fundamentals
  • Documentation guidelines
  • Anatomy
  • Physiology
  • Pathophysiology
  • Pharmacology
  • Medical and Surgical Procedures
  • Medical Terminology

10. Education and ongoing training is critical

  • “Based on industry feedback regarding the need for more time than the 40 hours of training we estimated for inpatient coders to learn both ICD–10–CM and ICD–10–PCS, we will increase our estimate of the number of hours of training that inpatient coders will need to learn ICD–10–CM and ICD–10–PCS from 40 hours to 50 hours, well within the commenters’ suggested range of as little as 5 hours of training, to a maximum of 80 hours.”
  • “For successful transition to ICD10, the challenge for inpatient coders is to:
  • Ensure they have sufficient foundational knowledge of the biomedical sciences
  • Learn how to apply both ICD-10-CM and ICD-10- PCS codes correctly on inpatient encounters
  • Understand how to apply maps and crosswalks between ICD-9-CM and the ICD10 systems “

Source: Role-based Model for ICD-10 Implementation: Inpatient Coder Tasks(published on AHIMA website in November 2009)