Thoughts before AHIMA: ICD-10 and your technical environment

October 1, 2013. That’s the compliance date for implementation of ICD-10-CM (diagnoses) and ICD-10-PCS (procedures). No delays. No grace period. Just a few days shy of only two years away.

For those of you dealing with initiatives related to ICD-10 compliance, few dates can hold as much significance. Among those of you headed to AHIMA, I’m sure the term alone induces no shortage of cringes or shudders. Some of you are ready, and that date carries no especially ominous undertones (though maybe some unpleasant memories as you undoubtedly earned that peace of mind through no small planning and effort). The rest of you are likely hovering at some point between “almost there” and “mired in discussions, meetings and general worry.”

Just to outline the scope of work and potential impact of ICD-10 implementation, let’s compare it to its predecessor, ICD-9.



ICD-9 contains approximately 13,600 discrete codes

ICD-10 contains approximately 69,000 – about three times as many

ICD-9 codes are mostly numeric, with E and V codes alphanumeric with valid codes of three, four or five digits

All ICD-10 codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter, and valid codes may have three, four, five, six or seven digits

A quick look at that table and one thing is glaringly obvious: implementing ICD-10 means accommodating a significantly greater amount of data. And that’s not even accounting for the requisite duplication of code sets over the two-year transitional phase.

Whatever your state of readiness, I hate to say this, but your work with ICD-10 will likely never be done. I am not referring to the fact that ICD-11 may lurk on the horizon (the good news is that much of the processes established in your migration to ICD-10 should lay the groundwork for those efforts). Neither am I talking about using the code in your day-to-day operations. That’s a given. What I mean is that it will be a constant effort to ensure that your processes and systems remain in a state that supports your usage of ICD-10.

That’s trickier than it sounds. I can think of few healthcare organizations whose technical environment remains constant over a relatively long length of time. Applications come and go. Vendor relationships change. Organizational needs adapt to serve dynamic, evolving communities. As those factors – and others – come into play, healthcare organizations need to ensure that every new module maintains full support of ICD-10 usage (not to mention the myriad of other regulatory standards).

Compounding the issue, you have those systems that might not seem to have a direct impact on ICD-10 implementation. Sure, there are the obvious applications – EMRs, billing systems, encoders and so on. But there are others that probably don’t leap to mind. ECM and document management, for example, may store and report ICD-10 codes on a purely transactional basis, but the fields in their data tables must be large enough to accommodate those longer codes. Don’t let something like that undo your hard work. Scrutinize every system and subsystem, new or old, that touches clinical care and the revenue cycle, however slightly.

If you’re attending AHIMA, swing by booth 413 to learn how ECM technology can support your ICD-10 initiatives and help you maintain a complete patient record.

Jared Blankenship likes words. He likes to read them. He likes to write them. And he likes to share them. That pretty much explains his decade spent in business and technology journalism. Rich in complexity and perspectives, the healthcare industry eventually replaced journalism. Jared has spent almost six years in the healthcare IT, humbled daily by the new things he learns and grateful to those willing to share their knowledge. He counts his time spent volunteering in a local ICU and onsite participation in two major Cerner EMR deployments as his most valued. And he looks forward to adding more.

Jared Blankenship

Jared Blankenship likes words. He likes to read them. He likes to write them. And he likes to share them. That pretty much explains his decade spent in business and... read more about: Jared Blankenship