ICD-10 Codes Implementation

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What is ICD-10?

• The biggest change in healthcare in over 30 years.
• ICD-10 is a new generation of diagnosis and facility procedure coding, which is going to have significant impact on how claims are documented and submitted.
• October 1st, 2015 -will increase from ~18,000 ICD-9 codes to ~141,000 ICD-10 codes. 
• ICD-10 codes will show much more specificity: laterality, degree of healing, type of visit, whether disease is new or recurring, trimester (ob-gyn), etc.
• Primary Care Superbill extrapolated from 2 pages to 27 pages
• CMS/HIMSS has recommended private practices have 6 months of cash reserves
• June 1st, 2015 many payers will begin requiring ICD-10 codes for all pre-authorizations with Dates of Service October 1, 2015 or later.

Steps to take to Implement ICD-10 in your EHR & Practice Workflow

Step One - Assessment

Please take our ICD-10 Client Assessment Survey to see where you stand with ICD-10 Readiness.

Step Two - Engage Physicians to Learn Required Documentation Elements

Know the differences between ICD-9-CM and ICD-10-CM Code sets

Characters used in Diagnostic Codes for ICD-10

The characters used in an ICD-10CM code contain a lot more detail than the previous ICD-9 code.

• Characters 1-3 are used to represent the category of disease.
• Characters 4-6 describe details of the diagnosis.
• Character 7 can be the episode of care; initial, sequential, or complications arising from the original episode of care.

ICD-10 is comprised on seven alpha-numeric codes. Some codes map directly to ICD-9 codes; many map to many different codes. ICD-10 uses combined codes for conditions and their associated symptoms. Two of the main differences from ICD-9 codes are Laterality and Expanded classifications. Laterality is the specific code for left or right ear, arm or other body part. Expanded classifications record status of disease and associate it with related combinations of disease characteristics.

Use of Adjectives in Description

Adjectives bring greater specificity to the ICD-10 code. Examples of adjectives include:

• acute or subacute
• chronic, intermittant, mild, moderate, severe
• primary vs secondary
• major

The general guidelines for coding different conditions will be sufficient for most providers.  Three conditions which require additional documentation from ICD-9 are: neoplasms, anemia and diabetes.

Neoplasms are coded as C00 - D49. They allow distinctions between:

• recurring
• malignent
• primary
• secondary
• In-situ

Neoplasms can also be documented as occuring in overlapping sites. An example that shows the difference between ICD-9 and ICD-10 coding of a neoplasm is shown below.

Anemia is another condition which requires documentation with more specificity regarding acute vs chronic blood loss and origin:

iabetes ICD-10 classifications range between E00 - E89. They cover Type 1 and Type 2, and complications using combination codes. They also document long term use of Insulin.

The classifications for Asthma include updated terminology and are classified in J00 - J99.

ICD-9 to ICD-10 Conversion - 1 ICD-9 code can convert to multiple ICD-10 codes

Here one ICD-9 code 814.00 converts to 12 ICD-10 codes:

Non-specified or the use of other in ICD-10 coding will result in the return of claims as queries and delayed reimbursements.

Step 3 - Translate All ICD-9 Codes Your Practice Currently Uses to ICD-10 Codes

Get to know the ICD-10 diagnosis codes commonly used in your practice and create a favorites list in your EHR.

Do chart audits to see how ICD-9 codes convert to ICD-10 diagnoses and if the documentation provided is adequate for being paid.

Step 4 - Detailed Questioning of Vendor and Payer Readiness

Ask your EHR vendor all that is required to upgrade to ICD-10. 

Make sure that your billers or billing company is prepared to handle ICD-10 claims. If not, consider going to an outside biling service that specializes in processing ICD-10 claims.

Step 5 - Form an ICD-10 Implementation team 

Ask one of the providers to be a champion on the team. 

Work with your EHR vendor or an outside consultant service to guide your team through the steps to implement ICD-10 in your EHR and practice.

Create a project plan for implementation of ICD-10

Step 6 - Create a test plan for the ICD-10 Conversion

 Implement the ICD-10-CM codes; leaving the ICD-9 codes in place in the test environment.

Step 7 - Run sample claims (837) to test the ICD-10 codes and billing levels

There are several benefits of billing in ICD-10 that if done right can increase your rate of billing and complexity of visit, bringing in greater revenues.

• Reduced coding error rates = reduced denials
• Describing higher complexity justifies higher complexity procedure/service payment
• Better data with which to justify better payment for physicians and pay-for-performance metrics
• Levels the insurance company tactics “playing field”

We can run test claim forms (837) for your practice.

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