All “covered entities”—as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)—are required to adopt ICD-10 codes for use in all HIPAA transactions with dates of service on or after the October 1, 2014 compliance date. For HIPAA inpatient claims, ICD-10 diagnosis and procedure codes are required for all inpatient stays with discharge dates on or after October 1, 2014. Transition to ICD-10 does not directly affect provider use of the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.
Some other facts about ICD-10:
Coders will have use thousands of new codes
Diseases aren’t changing. The codes on how to report them are changing to become more specific and dependable. Users won’t necessarily have to learn more new codes, but they will have to change ingrained habits on how to access more powerful and specific codes.
Coders will need to change their processes, workflow and beef up their knowledge of anatomy, and physicians will be required to shore up clinical documentation with more specific nomenclature in documentation that translates to effective coding. Vague descriptions of conditions by physicians and rote memorization by coders—or guessing what they think the correct code is—will no longer suffice with ICD-10. Training for staff is critical and cannot be overstated.
ICD-10 and EHR implementation are complementing each other
Some healthcare professionals are avoiding the task of transitioning from ICD-9 to ICD-10 because they are confused about priorities and feel caught between competing initiatives. But implementing EHRs, attesting to meaningful use, and transitioning to ICD-10 are closely aligned and complement each other. These initiatives together should be considered as a comprehensive package to improve documentation efforts.
A speedy, efficient EHR can ease the ICD-10 implementation. EHRs may streamline the coding process by functioning as coding crib sheets, providing boundaries and helping providers select the most appropriate code. Transitioning to ICD-10 ensures that EHRs, value-based reimbursement, and meaningful use incentive programs all speak the same language.
Detailed medical record documentation will be the Key for ICD-10 to be implemented
As with ICD-9-CM, ICD-10-CM/PCS codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for use when documentation doesn’t support a higher level of specificity. As demonstrated by the American Hospital Association/American Health Information Management Association field testing study, much of the detail contained in ICD-10-CM is already in medical record documentation but is not currently needed for ICD-9-CM coding.
ICD-10-CM-based super bills will not be long or complex
Practices may continue to create super bills that contain the most common diagnosis codes used in their practice. ICD-10-CM-based super bills will not necessarily be longer or more complex than ICD-9-CM-based super bills. Neither currently-used super bills nor ICD-10-CM-based super bills provide all possible code options for many conditions. The super bill conversion process includes:
- Conducting a review that includes removing rarely used codes; and
- Cross walking common codes from ICD-9-CM to ICD-10-CM, which can be accomplished by looking up codes in the ICD-10-CM code book or using the General Equivalence Mappings (GEM).
ICD-10 has great benefits for stakeholders
Everyone wins with ICD-10—from providers to patients. As mentioned, the specificity of ICD-10 is its forte. Because it facilitates more accurate diagnoses, ICD-10 enhances patient outcomes, supplements evidence-based research, and improves public health tracking and population health analysis.
As providers become more accountable for patient outcomes, less ambiguous coding will help specify reasons for patient noncompliance. Enhanced documentation of a patient’s condition will improve shared data with health information exchanges, facilitate auditing efforts, and decrease fraud and abuse. The ability to leverage ICD-10’s greater granularity will help increase reimbursement and establish more effective processes.
Time is perfect for the transition to ICD-10
Conversion from ICD-9 to ICD-10 CMS is long overdue. ICD-9 was created in 1979—before the identification of many diagnostic and technological developments that have occurred in the past 30 years. We need coding that matches recent medical discoveries and aligns with other developed countries that adopted ICD-10 years ago.