Editor's Memo

Switchover to ICD-10 Codes Poses a Daunting Challenge

John Marcille

Uncle Sam’s approach to health care coverage profoundly affects what goes on in managed care. Sometimes the influence is direct. Check out our stories on Medicare Advantage and MedPAC. Sometimes, less so. See our cover story and the patient satisfaction article.

As we were assembling this issue, the Department of Health and Human Services announced that it wants the switch from ICD-9 diagnostic codes to ICD-10 by Oct. 1, 2011. Never has three years seemed like so short a time.

“I’ve watched the ICD-10 storm cloud approach slowly and learned it will require some extensive retooling in claims processing, actuarial services, and finance,” says Jaan Sidorov, MD, a consultant and former medical director who sits on MANAGED CARE’s editorial board. “From a medical director’s point of view, there are implications for network management, disease and/or care management, and HEDIS.”

The fact that the announcement comes as no surprise does not detract from the coming challenge. HHS lays out both the nature of the test and why it couldn’t be avoided. “Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses,” the agency states. “ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year. By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures.”

Many readers by now have boned up on what to expect — at least as much as they’re able to. This is still a breaking news story and all the implications have yet to be explored. We here at MANAGED CARE will be doing just that in the months and years ahead. Change is coming.


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