What You Need to Know to Get Ready for ICD-10

To fully capture data on mortality and disease, the World Health Organization (WHO) developed the International Classification System, Tenth Revision (ICD-10). This revision, now used by most member states worldwide, provides greater accuracy in medical coding by dramatically increasing the number of categories and codes available.

In the United States, use of the ICD-9 remains widespread. By Oct. 1, 2014, every HIPAA-covered entity will need to convert to the ICD-10 for coding diagnoses and hospital inpatient procedures. Medical providers, coding professionals and insurance representatives must begin preparing today to be ready for this approaching deadline.

Part I: Why Do We Need ICD-10?

Several studies, including those published by the Perspectives in Health Information Management Journal and the American Health Information Management Association (AHIMA), have shown the three-volume ICD-10 to produce better data about public health diseases and mortality than the two-volume ICD-9. The tenth revision achieves greater accuracy because of its larger number of categories and more flexible coding system.

It is important to remember the ICD-9 is 30 years old, and as a consequence, contains many outdated terms and codes. Its structure, consisting of two volumes of mostly numeric-only codes of three to five digits in length, is static and unable to accommodate recent advances in diagnosis and treatment. For example, the ICD-9 still codes intentional self-harm as suicide, assault as homicide, and chronic lower respiratory diseases as chronic obstructive pulmonary diseases and allied conditions.

The tenth revision rights these wrongs. With the ICD-10, so many more codes are available that an additional volume has been added. As opposed to the ninth revision’s 17 chapter titles, the tenth has 21. And within each major category, individual diagnoses and procedures can be described more specifically because up to seven alphanumeric characters may be employed.

Say a patient fractures her left wrist in April and her right wrist in May; with the ICD-9, because the ninth revision does not distinguish right from left, additional documentation will be required. On the other hand, with the tenth revision, specific codes are provided to distinguish between left and right, initial versus subsequent visits and routine versus delayed healing.

Because of this, and to make American disease and mortality data compatible with that of the rest of the world, the Secretary of Health and Human Services (HHS) included the mandate that all HIPAA-covered entities switch to the ICD-10 as of Oct. 1, 2014. This directive (which is binding for all HIPAA-covered providers, payers, vendors, third-party billing services, and clearinghouses) applies only to diagnoses and hospital inpatient procedures; Current Procedural Terminology (CPT) coding for outpatient services and procedures is not affected.

Part II: Who Will This Affect?

This transition will greatly affect the work of medical care providers, third-party billers, and insurers. The Centers for Medicare & Medicaid Services (CMS) has developed guidance tailored to the needs of different entities.

Providers

CMS provides checklists and timelines for small and medium practices, large practices, and small hospitals to help with the transition to ICD-10. Although there are specific differences, some general guidance applies to all providers:

As soon as possible, begin communicating details of the transition to all staff. Immediately appoint a transition team and conduct an evaluation to identify how the revision will affect the practice or hospital. An assessment of software and systems, as well as a team of prepared service providers, would also be helpful. In addition, create a plan with milestones that includes a budget not only for anticipated costs, but for unexpected expenses and delays as well.

From now to December 2013, high level ICD-10 training should be conducted. By October 2013, providers should be testing claims and transactions with payers, billing services and clearinghouses. Finally, detailed training for all personnel should begin by January 2014.

Payers

A thorough review of payment and benefit policies is highly recommended for payers. As with providers, payers are advised to work closely with their vendors, billing services and clearinghouses on readiness, planning, timelines, testing, and training. CMS provides guidance for payers to help with ICD-10 implementation.

Software Vendors, Third-Party Billing Services and Clearinghouses

These entities are advised to work closely with providers and other partners to ensure claims are processed smoothly during and after the transition. As with other groups, CMS provides helpful vendor resources that focus on joint testing with providers and payers.

Individual Staff

The coding changes between the ninth and tenth revisions are far from insignificant. With ICD-9 diagnostic codes, alpha characters are limited to only two alpha digits and code lengths are limited to five characters overall. With ICD-9′s procedure codes, no alpha characters are used, and digits are limited to four. Conversely, with ICD-10, for both diagnoses and procedures, all alpha characters are available and the total number of digits can reach seven.

To help a staff manage these changes, AHIMA recommends 50 hours of training for hospital inpatient coders, who must become proficient with ICD-10-CM (Clinical Modification) and ICD-10-PCS (procedural classification system) and 16 hours of training for those who need to learn only the ICD-10-CM. Staff can find both online and face-to-face training as well as books and other guidance on AHIMA’s website.

Individuals with AHIMA certifications know they are always required by the Commission on Certification for Health Informatics and Information Management (CCHIIM) to earn a certain number of continuing education credits (CEUs) to be recertified. As part of the transition to the tenth revision, a portion of these CEUs must be ICD-10 specific. They are as follows:

Certification ICD-10 CEU’s Required
CHPS 1
CHDA 6
RHIT 6
RHIA 6
CDIP 12
CCS-P 12
CCS 18
CCA 18

The transition between the ICD-9 and ICD-10 has been long overdue in the United States; although there’s a lot left to do, we still have more than a year to prepare for it. Once new structures are in place and personnel are trained, implementation of the ICD-10 should ensure a more efficient and useful medical coding system.

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