Recently, the Final Rule set the implementation date of ICD-10 for April 1, 2014. Although this is over a year away, agencies should begin to make preparations now for a smooth transition from ICD-9.
ICD-9 was developed by the World Health Organization for worldwide use. The United States developed a clinically modified version which became ICD-9-CM, and this coding system was implemented in 1979. Since 1979, many new diseases have been discovered and named, as well as numerous changes in the health care industry. These changes caused a need for a more in depth coding system and are addressed in the ICD-10-CM system. For example, there are 17,850 diagnosis codes in ICD-9 and approximately 140,000 in ICD-10-CM. ICD-10-CM contains many new features such as the ability to better describe the locations of wounds, fractures, affected areas of strokes and so on. While we have general descriptions in ICD-9-CM such as hip or knee, we cannot currently describe left or right. ICD-10-CM will have the ability to code specifically right hip, left knee, right calf and so on. Because of this expansion, ICD-10-CM will expand the diagnosis code to a total of 7 possible alpha and numeric spaces, rather than the possible 5 numeric only codes in ICD-9-CM. ICD-10-CM also groups diagnoses in alphabetical sections rather than numeric chapters, and has a whole new set of coding rules to follow. When ICD-10 is implemented, coders will need to forget what they learned about ICD-9 and use this new set of rules and guidelines for coding.
The final rule began taking steps toward implementing ICD-10 years ago, and on June 14, 2012, agencies had to become HIPAA 5010 compliant. This transition to HIPAA 5010 was a big step in allowing the expanded 7-digit codes of ICD-10 to be populated on the billing statement. Now that the final rule has stated an “in stone” implementation date, agencies should get ready to implement these coding changes.
How can you prepare for ICD-10-CM Implementation?
1) Realize that your staff will need to be educated and trained. This is the first priority. Begin by educating staff on ICD-10-CM. CMS has projected that it will cost an agency approximately $644 per employee for training on ICD-10. There are some upcoming coding seminars available on Axxess’ website
2) Clinicians and billers will need to brush up on anatomy and physiology in order to use ICD-10 properly. Because the codes in ICD-10 are expanded to include the specific locations of the disease/injury/part of the body, staff will need to be competent in the terminology involved in assigning the proper codes and will need to know that their documentation will have to reflect this information to “paint the picture” for agency coders as well as Medicare and other payers.
3) Review the preliminary codes available in preliminary ICD-10-CM. Begin to read the coding rules for ICD-10 and familiarize yourself with the new rules. Again, the rules for ICD-10-CM will be different than ICD-9-CM.
4) Begin planning how you will manage some of the anxiety as your clinicians learn to code in the new ICD-10 environment. Know that they will have to query the physician in some instances to gain the information they need to code properly. You may also have lag time if you have a designated coder(s) who will need to call back and forth to the clinicians to gather more information in order to assign the correct code.
5) Choose staff members for your agency to be the designated ICD-10 implementation team. Begin discussing how the changes will impact your agency and start planning ways to manage these impacts now. Look at your policies and procedures, from intake through billing. Make changes as needed. Does the referral intake person need to begin physician query at the beginning of the referral process? Do you currently ask for operative reports or in-depth hospital records that may give anatomical clues that can be used in coding? Do you have enough staff members to make up the decrease in productivity and avoid bottle necking of data/billing? Who are you sending to seminars and webinars to learn about ICD-10? Is your clinical staff ready to fulfill the level of documentation needed so as not to impact your cash revenues? Are coders trained and ready to hit the ground running? Do you have enough coding staff/and are the coding staff members certified coders? Do you have audits in place for compliance reviews? Are your contracted staff knowledgeable and ready to comply with the changes as well?
By planning ahead, training your staff members, and making needed changes ahead of ICD-10-CM implementation, you will can be prepared and master the changes coming with ICD-10-CM.
Sources:
Decision Health Complete Home Health ICD-10-CM Diagnosis Coding Manual, preliminary edition
Lisa Selman-Holman, 10th annual Home Health Coding Summit, “State of Coding”.
CMS Final Rule 45 CFR Part 162 [CMS-0040-P] RIN 0938-AQ13
Retrieved from http://www.gpo.gov/fdsys/pkg/FR-2012-04-17/html/2012-8718.htm
Roseanna Porter, “ICD-10 Case Study: Build an ICD-10 Transition Plan and Team”.
