Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

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ICD-1 to ICD-11 Timeline Highlights Healthcare’s Evolution

By Jacqueline DiChiara

- Considering the past developments of ICD-10 – the tenth revision of the International Classification of Diseases – is imperative to best comprehend what’s next for the healthcare industry. From ICD-9’s inception via The World Health Organization (WHO) over 35 years ago to ICD-10’s kick-off this upcoming October, how far has the healthcare industry come in terms of progressions, advancements, milestones, setbacks, and opportunities with information capturing? Although answers to this question remain subjective, consider the following foundational ICD recap as a reflective basis for what the next several months, and beyond, may hold.

ICD-10 delay ICD-11 implementation

Selected highlights from ICD-1 to ICD-11

Beginning with what is generally considered the ICD inception of sorts and proceeding with a series of selected highlights leading up to today and tomorrow, it was during the mid-fifteenth century when recorded death registration efforts began in Italy. As great plagues swept nations, it became of great interest how and why the masses were dying. During this time, great advancements in the realms of medical education throughout Europe gained prominence. During the sixteenth century, within France, Switzerland, and the Netherlands, boards of health were established to track epidemics among cities.

England passed the Registration Act in 1837 with provisions to gather more information about deceased populations and various causes of death. ICD-1 was used internationally starting in 1909 with The United Nations delegating ICD-based responsibility to WHO beginning in 1946. The American Hospital Association (AHA) Central Office on ICD-9 was established by the Memorandum of Understanding as a Clearinghouse for ICD-9-based issues nearly two decades later.

ICD-8 went into effect beginning in 1968. One year later, WHO advised a series of ICD-9 specifications. Several years later in 1975, ICD-9 was published with its implementation becoming formalized in 1979. During this time, the number of diagnosis codes was expanded upon and the development of a procedural coding system made official headway.

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WHO adopted ICD-10 in 1990. ICD-10 now contained significantly more codes and categories. Compared to ICD-9’s 17,000 codes, ICD-10 now included over 155,000 codes. Four years later, WHO developed ICD-10 with a multi-faceted goal including a need for greater ambulatory care services, more clinical detail, and more efforts placed upon risk capture of disease.

A draft of ICD-10 became available within the United States beginning in 1995. The United Kingdom began using ICD-10 for reimbursement or case mixes during this year. The following year, the first draft of ICD-10 was completed. Thirteen new countries now adopted ICD-10 for morbidity coding purposes.

A first round of testing following ICD-10 development was conducted by the National Center for Health Statistics in 1997. Updates were made to terminology and disease classification to maintain usage consistency and remain up-to-date with medical advances. By this time, France, Denmark, Finland, Iceland, and Norway either began or had already begun using ICD-10 for reimbursement or case mixes.

The conducting of formal testing was conducted one year later. ICD-10 was also updated annually beginning this year, a time when France also began using ICD-10 for reimbursement or case mixes.

In 1999, the US began using ICD-10 to code and classify mortality data. Information was taken from recent death certificates. ICD-10 became a standard for hospital reporting. Belgium began using ICD-10 for reimbursement or case mixes.

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The Department of Health and Human Services (HHS) released the Health Insurance Portability and Accountability Act (HIPPA) a year later and explained what designated a HIPPA standard. Germany began using ICD-10 for reimbursement or case mixes the same year.

Canada joined the list of previous countries using ICD-10 for reimbursement or cases mixes in 2001. The World Health Assembly approved the International Classification of Functioning, Disability, and Health (ICF). A year later, ICD-10 was published in 42 languages, including 6 official WHO languages.

HIPPA named ICD-9 as a code set for the reporting of diagnosis and procedures related to electronic administrative transactions in 2003. HHS issued a proposed rule in 2008 to transition to ICD-10 on October 1, 2011. Stakeholders stated during this time that more time was needed for ICD-10 preparation.

Shortly after, HHS set October 1, 2013 as the ICD-10 transition date via publication of a final rule. This date granted healthcare providers an additional 2 years to meet and exceed their preparation needs. During this time, the Centers for Medicare & Medicaid Services (CMS) released general estimates ICD-10 implementation will be about 0.03 percent of revenue for inpatient and outpatient healthcare settings, other estimates including much higher numbers.

In 2012, The ICD-10 compliance deadline was pushed ahead to October 1, 2014 to diminish regulatory burden. A year later, the ICD-10 compliance date was delayed. Speculation about what would follow blossomed among the healthcare industry.

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In 2014, the Protecting Access to Medicare Act of 2014 (PAMA) was born which banned the Secretary from adopting ICD-10 before October 1, 2015. The ICD-10 compliance date was delayed. ICD-10’s compliance date was soon set for October 1. Two one-year delays had now occurred. WHO established 2017 as an ICD-11 release date. Waiting for ICD-11 had essentially become nothing more than a Beckett-induced “Waiting for Godot” moment, said the ICD-10 Coalition.

Does the past make way for the present?

As 2015 progresses, what is next on the healthcare horizon? One point of certainty is that within the past Spring alone, many ICD-based events have unfolded – for instance, the House’s proposal of an ICD-10 implementation freeze – which AMA supported – and its plan for a 2-year ICD-10 grace period, noted commentary from CMS released urging for increased claims flexibility, a CMS/AMA announcement intended to avoid financial disaster, complications stemming from missing language from SGR legislation, and end-to-end testing from CMS results deemed “successful.”

Both these new – and historically recorded – ICD developments are only a handful of highlights and are by no means considered extensive or finalized. As the healthcare industry uses the events of the past in true crystal ball fashion to authentically dictate what may be next come October 1, it is hopeful as the aforementioned timeline continues and time ticks onwards, the industry will thrive and advance – from ICD-10 to ICD-11 and far beyond.


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