efficiently and effectively assist other departments organization-wide in their conversion efforts. By automating much of
the conversion effort, organizations can focus HIM resources on
resolving conversion issues such as the diabetes example previously discussed.
Beyond the immediate challenge of converting the wide array
of ICD- 9–based systems to ICD- 10, there are the longer-term
opportunities afforded by ICD- 10.
With the detail available in ICD- 10, demand to express clinical
concepts in ICD- 10 codes will grow dramatically. Departments
such as utilization review and quality assurance will want to use
ICD- 10 to create operational systems that monitor utilization
and quality at a level of precision not possible under ICD- 9.
Contract negotiations with payers will inevitably evolve to
more precise coverage, guidelines, reporting, and other rules
based on ICD- 10. ICD- 10 will also require more complete, precise, and accurate documentation. Developing and maintaining
systems and improvement programs that benefit from the detail of ICD- 10 will require the expertise of HIM professionals for
their long-term success.
The implementation of ICD- 10 is the most significant event
for the HIM profession since the adoption of DRGs for Medicare
payment in 1983. Healthcare reform, pay-for-performance, and
public comparisons of efficiency and quality will create increasing demand for accurate and complete data. The additional
ICD- 10 Fine Print
specificity of ICD- 10 is essential for achieving these objectives.
For HIM professionals, ICD- 10 represents both an immediate
challenge and a long-term opportunity. ¢
AHIMA. “Putting the ICD-10-CM/PCS GEMs into Practice.”
Journal of AHIMA 81, no. 3 (Mar. 2010): 46–52.
Centers for Medicare and Medicaid Services (CMS).
“Converting MS-DRGs to ICD-10-CM and ICD-10-PCS.”
CMS. “General Equivalence Mappings.” www.cms.gov/ICD10.
CMS. “General Equivalence Mappings: Technical Documentation for Users.” www.cms.gov/ICD10/11b1_2011_ICD-
Mills, Ronald E., et al. “Impact of the Transition to ICD- 10 on
Medicare Inpatient Hospital Payments.” www.cms.gov/
Rhonda Butler ( email@example.com) is a research analyst and software
development specialist in the department of clinical and economic research;
Ron Mills is a software architect and division scientist for health information
systems; and Rich Averill is senior vice president of the department clinical
and economic research at 3M Health Information Systems.
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