ICD - 10, the tenth revision of International Classification of Disease (ICD) and a successor of ICD - 9 is a system of coding created by the World Health Organization that organizes and codes health information that includes diseases, symptoms, abnormal findi ngs, injuries, external causes of diseases and deaths. This information is used further for health statistics, epidemiology, health care management, allocation of resources, monitoring and evaluation, research, primary care, prevention and treatment.

ICD - 10 coding provides the detailed analysis of the general health situation of populations of different countries and monitors the prevalence of diseases and other health problems. This analysis goes through different stages of scrutiny and finally report ed, categorized and presented for important decision - making. ICD - 10 is divided into two systems:

In the US, the initial date of complying ICD - 10 system was set on October 1, 2013, which was later changed to October 1, 2015 because of the agitation among providers for adopting ICD - 10 system. The US is the only developed nation that is lagging behind as compared to the rest of th e world in using this most up - to - date system. Software companies seem to be ready for ICD - 10, and insurance companies are next in line. However, providers are still wondering as how to make the transition from ICD - 9 to ICD - 10.The purpose of this whitepape r is to bring to view the importance of the ICD - 10 transition testing and other components related to ICD - 10 testing.

ICD coding is important for health organizations and providers around the globe to compare and share health related data in a standard ized form . ICD is being revised to better reflect progress in health sciences and medical practice and compels the providers to adopt and implement t his advanced coding system.

There are two main reasons that make transition to ICD - 10 necessary:

First , p ayers face difficulty in paying claims using ICD - 9 because the system lacks advanced technological requirements and medical treatment. The limitations in ICD - 9 directly affect the diagnosis - related groups (DRG), a prospective reimbursement system to determine how much Medicare sponsors the hospital for each "product".

Second , the current ICD - 9 system does not give a clear picture of quality of care to healthcare industry. It is difficult for healthcare providers to assess the outcome s of latest procedures and existing health care conditions in the absence of precise codes.

Consequently , in order t o improve the productivity of providers, enhance quality health ca re services to patients, enhance clinical decision - making, track public health issues, conduct medical research, identify fraud & abuse and design payment systems to ensure services are appropriately paid, implementation of ICD - 10 system has becom e mandatory for the providers.

Over 25 countries have already adopted ICD - 10 to classify diseases and related health problems because of the many benefits it provides , such as:

ICD - 10 transition is a very complex and lengthy risk assessment process where t he number of diagnosis codes in ICD - 9 is 14,000 while it increases up to 68,000 in ICD - 10 , with procedure codes increasing from about 4,000 in ICD - 9 to 87,000 in ICD - 10 . In addition to that, ICD - 10 introduces alpha numeric category classification , which gives the users more clarity and precision in coded patient data . Hence, t o achieve accurate coding and billing , and to reduce the risk of claims and coding errors, the transition requires a s ignificant testing because it is a risk - mitigating program that ensures if the system is working accurately.

Claims and coding errors occur for two general but different reasons:

ICD 10 testing is a very lengthy and a complex proposition. A comprehensive ICD-10 testing framework requires multiple types of testing at different stages with different complexities. Testing is divided into two broad categories-internal and external testing.

External testing is crucial for providers according to the new regulatory requirement under the Affordable Care Act’s Operating Rules that outlines payer-provider testing. This kind of testing occurs on front-end as well as back end system. It requires compatibility between providers and payers usage of ICD-10 codes to make it successful.

Healthcare organizations consider following key points while undergoing external testing:




The Massachusetts Health Data Consortium has announced the launch of ICD-10 Collaborative Testing Program for many of the state’s health plans and provider organizations. It is introduced to reduce the significant time, costs and risks associated with ICD-10 compliance for the state’s health care industry. It will help respondents to address the potential issues and provide a structured, effective, and low-cost ICD-10 testing solution to the state’s healthcare payers and providers.


To achieve neutrality and progress in the ICD-10 transition, Saviance follows the Six Key Strategies:


The foundation for a successful ICD-10 Testing, however, is based on internal testing. When internal systems are working as expected then only business processes will yield results. This implies that the organization once done with its internal testing should look ahead for external testing. ICD-10 involves two distinct types of internal testing - the traditional IT System Code Testing and Business Readiness Testing. The latter is crucial for organizations that are looking forward to achieve their neutrality goal.

Team ICD 10 at Saviance works on the identification of relevant ICD codes for optimizing test coverage, including maximum usage, maximum reimbursement, etc. We facilitate ICD-10 QA using dual coded medical records and deliver end-to-end Internal & External Testing. By assuring smooth ICD-10 transition, while maintaining clinical & financial neutrality, we provide comprehensive ICD-10 support services to help ease the transition, including on-site business and technical support and 24x7 Help Desk.