The International Classification of Diseases, “ICD Codes” were originally developed to track how people died. In 1948, just after the creation of the World Health Organization, a committee was put together to establish one version to represent all countries. Subsequently ICD codes were used to track diseases and injuries and to find patterns that might show an epidemic could be coming, as well as to track the general health of people. Today ICD codes are not only used for this purpose, but for medical billing in the U.S.

The transition form ICD-9 to ICD–10 was agreed upon internationally to improve electronic communication by adding specificity to both diagnosis codes and Current Procedural Terminology “CPT” codes. Everyone covered by HIPAA must transition to ICD-10. The new codes are fundamentally different because they contain information that characterizes anatomic site, severity and other clinical details. The result is that diagnosis codes grow from 13,000 to 68,000, while CPT codes grow from 11,000 to 87,000. (CPT codes will only be changing for hospital inpatient billing. Outpatient providers and other clinicians will continue to use the existing CPT Procedure Codes together with the ICD -10 codes for billing.)

ICD 9 –CM

• It is 30 years old.
• Lacks details on patients’ medical conditions
• Lacks details on procedures and services performed on hospitalized patients
• Uses outdated and obsolete terminology
• Uses outdated codes that produce inaccurate and limited data
• Is inconsistent with current medical practice
• Not able to describe diagnoses and inpatient procedures of care now delivered

ICD-10-CM/PCS

• Incorporates much greater specificity and clinical information
• Improved ability to measure health care services.
• Increased sensitivity when refining grouping and reimbursement methodologies.
• Enhanced ability to conduct public health surveillance and audits.
• Over time a decreased need to include supporting documentation with claims. (Initially more supporting documentation may actually be required.)
• Includes updated medical terminology and classification of diseases.

ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM. These codes allow for a much greater degree of clinical detail and afford practitioners a better understanding of their patients’ medical condition. This should lead to more customized treatment plans and better tracking of outcomes.

 

ICD-10-CM has many new features allowing for a greater level of specificity. These include:

• Combination codes for conditions and common symptoms or manifestations
• Combination codes for poisonings and external causes
• Added laterality
• Added extensions for episode of care
• Expanded codes (injury, diabetes, alcohol/substance abuse, postoperative
• complications)

Practice owners are faced with many challenges right now; RAC Audits, G Codes, and PQRS to name a few. ICD – 10 is yet another potential pitfall for your practice. Being proactive in managing your business has never been more important. Here are some suggestions to ease the transition to ICD – 10.

• Improve Documentation Now:
  • ICD – 10 Codes will have a ripple down affect throughout many areas of your practice including payment and audits. Therefore they must be as accurate as possible.
  • Accurate coding cannot be achieved without the clinicians’ effort to provide good documentation.
  • The detailed information that is required to code using ICD 10 is also needed to create Treatment Plans that comply with Medicare requirements including “G Codes”. Clinicians must ensure that sufficient information is included in the medical record to satisfy these requirements.
• Develop the Relationship Between Coders (Billers) and Clinicians
  • Clinicians do not need to understand all of the intricacies of billing and coding, and billers / coders do not need to understand all of the clinical / medical — but they must work together to ensure optimal accuracy.
  • Clinicians must accurately, precisely, and comprehensively document the patient’s medical condition and level of functional impairment and the procedures performed.
  • Billers need to understand basic anatomy and the pathology of conditions commonly seen in a therapy practice to better understand the clinicians’ documentation.
  • Anything that practices and providers can do to improve and facilitate the working relationship between therapists and billers will contribute to a smoother transition.
  • Ultimately, practices want to encourage clear documentation by clinicians and accurate coding by billers.
• Institute Strategies for Training
  • Practice owners need to understand the impact of ICD – 10, identify the steps necessary to implement the move to ICD – 10 and the challenges that need to be addressed including people and technology.
  • Designate a specific person responsible for moving this transition through the organization.
  • Develop a timeline for training for office staff and clinicians starting at least six months before the implantation deadline (currently October 1, 2014).
  • ICD-10 codes can not be used in actual billing until the official start date, however most payers have a process in place that allows for testing in advance. Effective testing will prevent interruptions in cash flow once the official transition is made.

• Locate the Resources for Help
  • Official resources are available at the Centers for Medicare & Medicaid Services (CMS) ICD-10 website. The site has a number of free papers to help in implementation, and includes all the official codes and guidelines. Implementation guides for both small and large practices are available that walk the user through the process.
  • There are 2 major, well-respected, accredited societies that offer training for coders/billers: the American Association of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).
  • Genco Healthcare Management is working closely with the team at Billing Dynamix to provide training and other services to their clients. We can be reached at 914-713-3606 or by email David@Gencohealthcare.net.

We are grateful to Joseph C. Nichols MD whose writing for Medscape Education in 2012, inspired some of the suggestions contained in this blog posting.