MLR

ICD-10 coding system: The clock is ticking

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By Michael S. Lewis, MBA, FACMPE, CPAmerica affiliate Cowan, Gunteski & Co., P.A.

Tick Tick Tick

Time is running out to begin preparing for the implementation of the change to the ICD-10 diagnosis system on Oct. 1, 2014.

doctor and nurse

Many people in the healthcare industry are not aware the ICD-10 was released by the World Health Organization in 1993. It has been commonly used throughout the rest of the world for almost 20 years – with the exception of the United States and Israel. The current diagnosis coding system, ICD-9, has been used by physicians in the United States since 1979.

Many healthcare experts believed that ICD-9 was obsolete. Annual updates to ICD-9 didn’t keep up with changes in medicine, and the coding structure lacked specificity. The lack of specificity has resulted in rejection of claims submitted to payers, requiring further follow-up and submission of documentation and delays in payments to practices for services rendered.

ICD-10 is more than just an increase in code and field size. This change will have a pervasive impact on the healthcare industry – providers, payers and system vendors.

There is an ICD-10 code for every conceivable problem. Some of the more unusual codes are:

  • V95.42XA – forced landing of spacecraft crash injuring occupant, initial encounter
  • Y92.250 – injuries encountered in an art gallery
  • W55.41XA – bitten by pig, initial encounter
  • T750.1XD – shock due to lightning strike, subsequent encounter

ICD-9 codes are three to five characters in length, with the first digit being either numeric (also digits 2-5) or alphabetic (E or V). There are approximately 13,000 ICD-9 codes. ICD-10 codes are three to seven characters in length with the first digit being alpha, digits two and three numeric, and digits four through seven numeric or alpha. There are approximately 68,000 ICD-10 codes.

Each major body/organ system in ICD-10 begins with a different letter of the alphabet – for example, all endocrine, nutritional and metabolic disease codes begin with an E, and all diseases of the nervous system begin with a G.

A common misconception about this major coding change is that there will be a one-to-one correlation for all codes. That is true for only 24.2 percent of the codes. An example of this is ICD-9 code 157.0, which is for a malignant neoplasm of the head of the pancreas. The corresponding ICD-10 code is C25.0.

An example of one-to-three mapping is ICD-9 code 649.51, which is bleeding during pregnancy. In ICD-10, this becomes three codes – O26.851, O26.852 and O26.853, which translate to bleeding during a specific trimester of pregnancy.

The most daunting challenge is for code 733.82, which is nonunion of fracture, pseudoarthrosis in ICD-9. This becomes 2,530 separate codes in ICD-10 – quite a challenge for orthopedic specialists.

The change in coding systems will impact every area of a medical practice. Many practices are anticipating the impact on billing from changing encounter forms to ensuring that practice management vendors update software to accept ICD-10 codes.

The other major change will be in documentation of patient encounters, whether in the office or any other setting. Documentation must be consistent with the codes selected and billed to insurance carriers.

Providers should already be thinking of how they will have to change the way they document every visit. Practices must ensure that electronic medical record systems, as well as practice management systems, are set up to generate and accept the new codes.

Practices should develop a work plan to address all of the factors involved in this coding change. The work plan must be implemented with the participation of both staff and providers. A determination must be made as to who will need training on ICD-10 and the level of training necessary. If training is done during office hours, it may mean that patients will need to be canceled. If training is done after hours, expense for overtime may be incurred.

No one can predict how the conversion will go on Oct. 1, 2014. Other conversions, such as the one to the 5010 claim formats, were fraught with problems and payment delays.

It is strongly recommended that practices accumulate at least 30 days of cash on hand to protect against delays in reimbursement and claims processing. Practices should contact every major payer to determine whether they will switch to ICD-10 on Oct. 1 or will continue to use ICD-9 for some period of time.

Only Medicare is obligated to make the change on Oct. 1. It is elective for other payers. Preparation and planning is the key to a successful conversion to ICD-10.