ACC.14: Don’t wait for ICD-10 to get more specific in coding

WASHINGTON, D.C.—Providers need to stay ahead of the transition to ICD-10 because it will result in an increased burden to be more specific in documentation and require a deeper understanding of applicable codes, according to a March 29 presentation at the American College of Cardiology (ACC) scientific session in Washington, D.C.

ICD-9 is 30 years old and is hampered by outdated terms, explained Robert N. Piana, MD, of Vanderbilt Medical Center in Nashville, Tenn. The structure of ICD-9 is also a limitation and doesn’t allow for much flexibility. “It limits the number of new codes that are available and many of the categories within ICD-9 are actually completely full and there’s no flexibility.”

ICD-10 grows the field length from between three and five characters to between five and seven characters, which in turn increases the number of available codes from approximately 14,000 to 69,000. This allows for more information per code, said Piana. ICD-10 also will offer better support for care management and analytics, as well as enhance the quality of data for public health conditions and research.

The move to ICD-10 is a major transition, and EHRs must be capable of handling the new codes, underscored Kenneth P. Brin, MD, PhD, of Advocate Medical Group in Oak Brook, Ill. “Your EHR needs to be upgraded to handle ICD-10. It’s as simple as that. If your business office, if your IT people haven’t implemented that yet, you’re in deep trouble at this point because it’s not a simple swap from ICD-9 to ICD-10.”

EHRs should provide a process to transition problem and diagnosis lists to include ICD-10 granularity, and Brin recommended checking ICD-10 software by looking at code 424.1. That’s the ICD-9 code for nonrheumatic aortic valve disease, and it’s the same code for severe aortic stenosis without regurgitation, severe aortic regurgitation without stenosis or both. In ICD-10, though, it translates to I35.x, where x is a variable that can allow for more granularity.

Brin also explained that coding depends on date of service, not the billing date, so services rendered before the transition will be coded with ICD-9 even if they aren’t billed until later. In addition to the EHR and billing systems, radiology information systems must be verified to be ICD-10 compliant and that they can pass both ICD-10 and ICD-9 codes successfully.

The scope of the transition was put into perspective by Linda Gates-Striby, CCS-P, ACS-CA, of St. Vincent Medical Group in Indianapolis. She said that when printed out on paper, ICD-10 adds 3.7 pounds. If the pages are laid side by side, the additions to cardiovascular disease alone total more than 15 feet in length.

“ICD-10 implementation is a little bit like eating an elephant; you have to do this one bite at a time,” she said.

While using a more granular coding system will be a challenge, Gates-Striby said ICD-9 has more specificity than providers often realize. For instance, ICD-9 has options for hypertension with congestive heart failure and/or chronic kidney disease. “These options for additional hypertension codes exist now. Why aren’t you using them? We should be. And you can do that before 10 comes along.”

Late last week the U.S. House of Representatives passed a “doc fix” bill that included a push back of the ICD-10 compliance date to Oct. 1, 2015. But even if the Senate votes in favor of the bill and the president signs it, the ramifications of the coding transition will be just as serious whenever the switch actually occurs.

“Implementation risks are real simple; don’t do it right, you’re not going to get paid,” said Brin. “Any failure at any level is going to compromise your business.”