For most people, seeing the term ICD-10 means nothing. For those in health care, though, this is a very big deal. Medical billing and coding personnel will be significantly affected, along with hospitals and physicians offices and pretty much every other medical entity you can think of. For people in the United States, it's a fundamental change that's going to be a mess.

ICD stands for International Classification of Diseases. Basically, this is the listing of diagnosis codes. Right now we're on Version 9; we've been on Version 9 since the 1979. The rest of the world changed decades ago, but we didn't because insurance companies, led by Medicare, decided to start paying inpatient claims based on diagnosis. Then payments on surgical procedures started being paid on the same standard.

ICD-10 is going to represent something very dramatic to the claims processing process. An ICD-9 looks like this: 250.00. An ICD-10 looks like this: 250.0019. Each of the numbers after the period stand for something, and if one of the early categories doesn't fit but a later one does, then a "x" is supposed to go in, like this: 250.00x5.

This is a fundamental change for many reasons. One, it's now possible that what's now a standard diagnosis (250.00 stands for diabetes) could suddenly become a major diagnosis based on what's related with the diabetes.

Two, you know those encounter forms you see in physician's offices and clinics? Suddenly there's going to be a lot more codes all over those sheets, which could be a mess.

Three, both physicians and medical records personnel are going to have to go back to learn how to do the new coding, all while keeping up with the work they're doing now.

Four, not all insurance companies have to change, such as compensation and no fault, since each state has different rules for it and it's not regulated in any way by the federal government.

Five, most computer systems aren't set to accept these new types of diagnosis codes, which means there's going to have to be a lot of money spent on updating computers while at the same time spending a lot of money to update computer systems for electronic medical records per the Health Care Reform Bill.

Six, most insurance companies probably aren't going to be ready for this change. This is based on history, as most weren't ready for earlier changes to procedure coding back in the early 2000's. So, even if hospitals change, insurers, especially almost every Medicaid system in the country, will probably tell everyone to keep coding the old way until they're ready.

Big deal? You bet. The implementation date is 10/1/2013, and though that seems like a long time away, think about this; HIPAA (Health Insurance Portability and Accountability Act) was passed in 1997 and some of its directives still aren't in place.

What does this mean to the average citizen? One, it means getting your health care expediently as it gets nearer to the time of implementation and months afterwards might not happen as everyone tries to figure out how to do the new coding. Bills might not go out as quickly, which means payments to the hospitals will be impacted and, if you owe money on the back end, you might not know about it as soon. Some people love that, but there's always this snowball effect when things like this are put into place that people aren't prepared for because it's an unknown entity.

Another thing that could happen is it could be harder for awhile to get insurance authorization for procedures because insurance companies will have to figure out how to categorize similar diagnoses in new ways. That will have an impact on who gets surgery at what time; that's scary.

And, of course, there will probably be new fee structures on services, and trust me when I say that any time there are new fee structures, they're almost never benefiting providers, and if these folks, hospitals, physicians and the like, are hurt by any of this... well, let's just say health care could get leaner by default and people will be wondering who's going to be providing their care.

Alarming? Well, it's meant to be. The truth is that things will probably fall somewhere in the middle; some will be ready, others are going to be totally caught off guard. Of course no one should be; I wrote about it in this article on ICD-10 and CPT-5 back in 2006, and this is one of the most read articles on the site it's listed on.

At least at this point no one can say that they don't know about it now that I've written about it, unless they don't come read this post. And I know they will. 🙂