With the transition from ICD-9 code sets to ICD-10 codes looming, a recent American College of Cardiology (ACC) survey showing nearly 65 percent of cardiologists are unclear about the new requirements suggests greater provider education is needed.
The codes sets are used to report medical diagnoses and inpatient procedures. The transition deadline, which was initially slated for October of this year, was delayed until Oct. 1, 2015 as part of the Protecting Access to Medicare Act that passed in April. The transition does not affect CPT coding for outpatient procedures and physician services, but it will apply to diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.
Given that the number of ICD-10 diagnoses codes will grow to 69,099—nearly five times the number of ICD-9 diagnoses codes—the Centers for Medicare & Medicaid Services (CMS) has urged healthcare organizations, from large national plans to small provider offices, laboratories, medical testing centers and hospitals, to allocate six to nine months for the transition. The shift will require significant changes to the way coding is done and organizations need to allow time to identify impacts; develop an implementation plan and timeline; work with vendors on new software and/or systems to accommodate the new codes; and coordinate with vendors, payers and other business partners to test transactions and processes.
The good news, according to the survey, is that nearly three out of four cardiologists are starting to plan or have a plan in place for ICD-10. Slightly more than 20 percent of respondents said they are ready to begin implementing ICD-10 in their practice.
However, the majority of survey respondents indicated a poor understanding of the ICD-10 requirements and consequently may require additional education. The ability of clinicians and coding staff to select an appropriate diagnosis code was cited as the area of greatest difficulty in relation to ICD-10, followed closely by concerns about documenting the patient encounter (58 percent) and the ability to compare ICD-10 data to ICD-9 data (56 percent). The survey also suggested concerns about the financial impacts of ICD-10, with 40 percent of respondents indicating the transition will likely have a negative financial impact and the remaining majority noting uncertainty.
The ACC is closely following CMS and industry efforts surrounding ICD-10 implementation and has developed several tools to help members understand the ICD-10 requirements and plan accordingly. Additional resources will be posted as they are available. For more information, visit CardioSource.org/Coding.
Debra Mariani is the American College of Cardiology’s coding and physician reimbursement associate.