The International Classification of Diseases, 10th Edition (ICD-10) was adopted by the World Health Organization (WHO) member states in 1994 and was scheduled for implementation in the United States later this year. However, this updated coding system has been delayed until October 1, 2015. ICD-10 consists of two parts: Clinical Modification (CM) for diagnosis coding and Procedure Coding System (PCS) for inpatient procedure coding. Coding for outpatient procedures is not affected. It is important to understand ICD-10 because it affects everyone covered by HIPAA, not just those who submit claims to Medicare or Medicaid. It will be the new baseline for clinical data, clinical documentation, claims processing, and public health reporting. This article will focus specifically on ICD-10-CM.
The transition to ICD-10 is necessary because ICD-9 is outdated and lacks sufficient detail. Physicians will be required to be more precise in documenting patient visit details. ICD-10 expands the number of diagnostic codes from 13,500 to 69,000 for better specificity.
The new code format is similar to that used in ICD-9 but now up to 7 digits are required. Specifically, the first 3 digits refer to the heading of a category, digit 1 is alpha, digit 2 is numeric, digits 3-7 are alpha or numeric, and a decimal appears between the 3rd and 4th digits. Digits 4-6 refer to details about etiology, anatomical site, and severity. Also, codes may have placeholders (an “X”), and only certain categories have a 7th digit that specifies information about the characteristics of the encounter. Almost half the codes use laterality (1-for right eye, 2-for left eye, 3-for bilateral, 9-for unspecified), combination codes are used to capture disease complexity, and there are two types of excludes notes.
The transition from ICD-9 to ICD-10 is a process that will require time and expense. Success will depend on being prepared, so here are some suggestions to get ready for implementing ICD-10:
- Start early.
- Establish a transition plan and a transition team or leader.
- Create a budget.
- Evaluate your use of codes and determine how ICD-10 will affect your medical record documentation.
- Discuss your plan with your staff.
- Check with payers, vendors, and other business partners regarding their readiness and testing.
- Test your ICD-10 systems in advance to make sure they will be ready by the compliance date.
For practices with electronic medical records, the transition should be relatively easy. Coders will continue to be able to code but will need to learn the new system. Here are some guidelines for using ICD-10:
- Alphabetical index: look up the diagnostic term in this index to find its code.
- Tabular list: look up the code in this list for special coding instructions.
- Instructions: follow the code’s instructions and all cross-reference notations (i.e., mutually exclusive codes [Excludes 1 and Excludes 2 notes], glaucoma staging).
- 7th digit: when indicated add the appropriate final digit. For an injury or trauma code, use A-for initial encounter, D-for subsequent encounter, S-for sequela. If there is no 6th digit, then an “X” placeholder is used in the 6th position. For glaucoma staging, use 0-for stage unspecified, 1-for mild stage, 2-for moderate stage, 3-for severe stage, 4-for indeterminate stage.
We still have more than a year before the implementation deadline of October 2015, so there is no excuse for not being ready, and besides, the penalty in lost reimbursement could be significant to your practice if you fail to be compliant.
Many resources exist for learning more about ICD-10 and its ramifications. I have already seen numerous articles in the trade newspapers and magazines, and I am sure many more will appear over the next year. Additionally, the following websites are dedicated to this topic:
- CMS ICD-10: This site from the Centers for Medicare & Medicaid Services contains complete information on ICD-10 including timelines, planning, resources, and downloadable code tables and guides. Particularly helpful are the General Equivalence Mapping (GEM) and crosswalk mapping tools for code conversion from ICD-9 to ICD-10
- AAO: This site from the American Academy of Ophthalmology has ophthalmology specific references such as timeline, checklists, FAQs, CODEquest seminar schedule, and other information.
I hope your transition to the new ICD-10 system is as quick and painless as possible.