On Oct. 1, 2013, physician practices and hospitals will be required by CMS to have transitioned from the 30-year-old ICD-9-CM codes to the ICD-10-CM (clinical modification) and ICD-10-PCS (procedural coding system) codes. The switch will cost time and money because ICD-10 has nearly nine-times more codes. Many practices and facilities, however, have not even begun a preliminary assessment of what the transition will require, which could negatively impact their bottom line.
Time is of the essence
The ICD-10 codes will have different code compositions, level of detail and structure, and will expand the number of ICD-9 codes from almost 17,000 to approximately 155,000. ICD-10 will be broken down into two categories: procedural and diagnostic code sets. ICD-10-CM will jump to 68,000-plus diagnostic codes from the current 14,000. The new procedural codes, which will be integrated into the hospital setting but not independent practices, will increase from the current 3,824 designations to 72,589.
The old codes can no longer keep up with advances in technology, improvements in procedures and reclassification of disease states, according to many healthcare providers and regulators. The new codes will allow greater specificity and enable more claims to be processed without rejection.
“We have seen in recent years, especially with the increase in medical necessity requirements, many more claims being rejected,” says Kim Charland, vice president of consulting at MedLearn in St. Paul, Minn. “ICD-9 is definitely out of date and many of its categories are full, resulting in codes being placed in sections that are not pertinent, and making selection more difficult.”
Two advisory groups—the North Carolina Healthcare Information and Communications Alliance and the Workgroup for Electronic Data Interchange—estimated that the complete ICD-10 conversion process will take providers 966 days to complete. This means that facilities should have started the planning process Jan. 18, 2010, to comply with the Oct. 1, 2013, deadline.
“ICD-10 is the biggest thing to hit healthcare in a very long time and everyone needs to start preparing now to ensure a smooth transition as the compliance deadline rapidly approaches,” says Charland.
Yet, some practices may be dodging the implementation phases in hopes of an extension, says Robert Tennant, senior policy advisor at the Medical Group Management Association (MGMA). Because the government has delayed HIPAA requirements and other deadlines in the past, practices feel it may delay the ICD-10 conversion and do not want to spend money now if they don’t have to, says Tennant. He adds that CMS has firmly stated that it will not grant any additional extensions.
Study findings published in the September issue of the Journal of AHIMA (American Health Information Management Association) affirmed that most practices and facilities are lagging in their transition. Of the 838 AHIMA members surveyed, 59 percent said they had not yet begun either 5010 (an update to insure the new codes conform to HIPAA compliance) or ICD-10 implementation and 20 percent said that they would not begin preparing to make the switch for another six months. Only 6 percent said they were almost finished with implementation, while 10 percent said they were half done.
AHIMA suggests that not implementing the appropriate steps to prepare for the ICD-10 transition could jeopardize reimbursement and result in increased claims rejections, thus making it important to begin the transitionary process to ICD-10 now, rather than later.
Fixing what’s broken
Because the current ICD-9 codes do not accommodate various disease states or recent medical advances, they prohibit coders from adding proper specificity to medical claims. With ICD-10, coders will be exposed to greater granularity and laterality.
While the jump in the number of codes seems “astronomical, there really is a method to the madness,” according to Peggy Hapner, consulting services manager at MedLearn. “In fact, ICD-10 is much more logical than ICD-9. Generally, ICD-10-CM incorporates greater specificity, clinical data and information relevant to ambulatory and managed care encounters.”
The increased laterality will allow coders and other staff to identify exactly where an injury or procedure takes place in the body. In ICD-9, for example, coders could not specify whether a broken wrist occurred on the left or right side of the body. Additionally, the increased level of granularity