Getting from ICD-9 to ICD-10

Richard Vander Burg, RN, BSN

October 2011, Vol 1, No 3 - Reimbursement

The deadline for going live with the International Classification of Diseases (ICD), 10th edition is October 1, 2013, and the Centers for Medicare & Medicaid Services repeatedly has attested this as a firm deadline with no extensions, delays, or grace periods. After the deadline for transition, providers will not be able to use the clinical modification (CM) of the 9th edition, that is, the ICD-9-CM codes. The implication being: If you aren’t live with ICD-10-CM, you won’t get paid.

When we hear ICD-10 in the United States, it usually refers to the nation’s latest clinical modification of the ICD, which was developed to support reimbursement coding, called ICD-10-CM. The ICD-10 procedural coding system, designated as PCS, will replace codes in volume 3 of ICD-9-CM in the United States. The Current Procedural Terminology code set will remain unchanged for physician services.

So what’s the difference between ICD-9 and ICD-10? The big change has been the increase in the level of detail that will be reported using ICD-10 codes. Within ICD-9, there are about 13,500 valid codes compared with more than 68,000 codes in ICD-10. ICD-9-CM has a maximum of 5 code elements, whereas the new codes have up to 7 alphanumeric digits.

The transition from ICD-9 to ICD-10 has the potential to impact all areas of how a practice operates. Of particular importance are 3 areas that every practice manager should consider in developing a transition plan.

1 Scrutinize vendors. Are they up to speed? Many vendors support revenue cycle management for medical practices. The good ones will be well on their way to completing internal testing of a change to Version 5010 of the Electronic Data Transactions protocol. The deadline for making the transition to this new protocol is well in advance of the deadline for ICD-10 implementation at January 1, 2012. It is important to understand a vendor’s progress toward completing this transition and to develop a joint plan for implementing the change in your practice that allows ample time for addressing challenges that may arise during the rollout.

2. Evaluate your coding solution. Is it the right solution for the future? With the increased complexity of the code structure of ICD-10 compared with ICD-9 and the underlying need for increased knowledge of medical terminology and anatomy, it is important to evaluate if your coding capabilities will meet your requirements in the ICD-10 world. Considerations about optimizing clinicians’ time with patients and the amount of training required for the entire practice workforce, coupled with the increasing availability of remote coding as a business solution, provide medical practices with many new drivers in selecting a coding solution.

Key considerations that can be used in evaluating current versus proposed coding solutions include the amount of time to code a chart, the accuracy of the codes, and cost (both the actual cost plus the opportunity cost associated with delayed reimbursement). Even if your current coding solution will be adequate for your expected future needs, a “plan B” should be considered to provide additional coding capability during the period of the transition from ICD-9 to ICD-10.

3. Train everybody. The implications of the transition will impact every facet of a practice. For this reason, everybody needs training. The level of training will range from general awareness training on what is involved in the transition and your practice’s plans for change all the way through detailed coder training on how to apply the new code set. Training everybody to the appropriate level will ensure that this is a practice-wide initiative with all staff equally invested in the success of the ICD-10 implementation.

The looming transition to ICD-10 will require changes in how your practice operates. Now is the ideal time to evaluate the current solutions used for revenue cycle management in light of the new business requirements of operating in the ICD-10 environment. Critical consideration should be given to evaluating your vendor’s capability to grow with you and support you, the applicability of your current coding solution for the future, and the need for training across the entire practice.