The clock is ticking toward implementation of ICD-10-CM on October 1, 2014. There is much to learn, and now is the time to begin if you and your agency has not started already.
There are several things that ICD-10-CM will do. These are a few examples:

1. It will give the home care industry the ability to be more specific about what we are doing for the patient. ICD-10-CM increases diagnosis codes to approximately 68,000 codes from the near 15,000 codes in ICD-9-CM. This means we can indicate such things as the right or left side, healing versus non-union of fractures, and what type of encounter is being provided.
2. ICD-10-CM will increase accuracy of billing and payments since Medicare will be able to see up to 25 diagnoses on the HCFA1500 bill.
3. ICD-10-CM will give clinicians many more options for coding diseases. Many diseases that require 2-3 codes in ICD-9-CM will be combined into one code in OCD-10-CM. An example is E11.321: Type II Diabetes with Mild Non-Proliferative Diabetic Retinopathy with Macular Edema. In ICD-9-CM we would have to code 250.50, Diabetes With Ophthalmic Manifestations, type II, not stated as uncontrolled; followed by 362.04, Mild Non-Proliferative Retinopathy; followed by 362.07, Diabetic Macular Edema.
4. Transition to ICD-10-CM will align the United States with other industrialized countries worldwide who have been adopting and using ICD-10 since 1994.
5. ICD-10-CM will allow updated medical technology and discoveries to be included in the code set. ICD-9-CM is over 30 years old, and has run out of room to add many diagnosis and procedures that have changed or been discovered since the 1970’s

There are many things ICD-10-CM will NOT do. The following is a partial list.

1. ICD-10-Implementation is NOT optional. All settings who currently use ICD-9-CM codes will be required to use ICD-10-CM codes beginning October 1, 2014.
2. ICD-10-CM will not have a grace period. Medicare will basically “flip the switch” on October 1, 2014. If you aren’t ready, you will not get paid for the services you provide.
3. ICD-10 will not have complete GEMS or crosswalks. Because of the sheer number of codes in ICD-10 as compared to ICD-9, as well as new combination codes and laterality, there is no reliable way to accurately translate codes from ICD-9 to ICD-10. Coders will have to go back to looking up codes in the alphabetical index and double checking them in the tabular index.
4. ICD-10 will not be self-explanatory. It will also not follow the coding guidance from ICD-9-CM. All the rules will start new with ICD-10-CM.
5. ICD-10-CM will not use aftercare codes for fractures. In ICD-10-CM we will code fracture codes. These expanded fracture codes will include what bone, what side of the body, and whether or not the bone is healing normally or having complications such as non-union.

There are many other changes that ICD-10-CM will have on your agency. The key to success is planning and preparation. If you have not already selected an implementation team and began training, it is not too late. However, you need to get ready today. Implementation timelines are available at www.CMS.gov.

Sources:

• www.cms.gov
• www.cdc.gov
• www.ahima.org