The ICD-9 International Classification of Disease, 9th Edition, is a coding system basically used for mortality statistics, once considered to be the foundation of reimbursement(o’Shea, 2015). Becoming popular in medical billing led to the establishment of the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), which is a revision of the original ICD-9.
The ICD-9 is linked to a hospital inpatient PPS (Prospective Payment System) and DRGs (Diagnosis Related Groups) to report diagnosis or inpatient procedures to CMS insurance companies for reimbursements.
This is mandatory when filing reimbursement claims with the federal government and private insurance companies. Running low on numbers for codes with limited space the ICD-9-CM cannot provide acceptable clinical specifications when describing various conditions resulting with addition documentation need to support claims. Resulting in an ineffective system for a needed effective monitoring utilization resource for accurate reimbursement rates and coverage or measuring the safety, quality, and care for example.
In 2003 the AHIMA director of coding policy and compliance, Sue Prophet testified in front of Congress, “AHIMA believes that adoption of a replacement for the ICD-9-CM diagnosis codes is an absolute necessity, as ICD-9-CM is more than 20 years old (implemented in 1979) and has become outdated and obsolete, (Hazelwood, 2003).
As the medical field advance, most medical professionals are adopting the ICD-10-CM. Which went into effect on October 1st, 2015. This system is expected to improve quality with up-to-date data, which will provide the patients with better care. Major changes include logical forms such as grouped conditions, descriptive codes, postprocedural/postoperative conditions, even codes for pregnancy and trimester conditions.
Also, introducing many new codes that ICD-9-CM didn’t offer or classify. The ICD-10-CM is designed to give a more detailed story for a better understanding for more accurate results.
I think this new system is going to improve the coding system in a major way. Besides all the money and time for preparation to transition to this new and improved system, I think it will be worth it and beneficial for all parties and patients. Though other countries have experienced success in the transition, it will take time to see results.