With the Oct. 1, 2013, implementation date for adopting the new ICD-10-CM diagnosis codes rapidly approaching, it is critical that practice leaders become aware of the impact this change will have on their organizations. While the transition to ICD-10-CM will affect many of the clinical and administrative staff of the practice, those individuals who directly input ICD-10-CM codes in particular will face significant challenges.
Practice Makes Perfect: Prepare now for ICD coding transition
To compare the current ICD-9-CM code set to ICD-10-CM, consider these differences:
The number of codes increase from approximately 13,000 in ICD-9-CM to more than 68,000 in ICD-10-CM.
Digit 1 will be alpha (A–Z, not case sensitive), digit 2 is numeric, digit 3 is alpha or numeric, and digits 4–7 are alpha or numeric. In addition, the Chapters in ICD-10-CM have been expanded from 19 chapters to 21 chapters.
The “look” of the ICD-10-CM codes is different and will require some adjustments. If a code under ICD-9-CM requires only four digits, it looks like this: 401.9. But under ICD-10-CM, each “place” is dedicated to a specific factor, and when a factor is not needed, an “x” is inserted as a “placeholder,” which is a new concept to coders. An example is “hypothermia” which can be reported with T68.xxxA, since the base code T68 describes hypothermia, but requires a seventh character of “A” initial encounter, “D” subsequent encounter or “S” sequel “a”(?).
ICD-10-CM codes are far more specific, requiring significant adjustment by the coder. They include, for example: (1) laterality; (2) obstetric codes that identify trimester; (3) expanded injury codes set, with a different grouping approach (by site rather than by type of injury); (4) severity (acute/chronic); (5) episode of care (initial, subsequent); and (6) an expanded sets of codes for postoperative complications.
The look of the “tabular” section has been replaced in ICD-10-CM with full code descriptions for every code. No longer will the coder have to search for the beginning of the sub classification, classification or chapter to figure out how to apply the coding rules.
Practice leaders should be proactive when preparing to implement ICD-10-CM and prepare a strategy for the practice to follow to ensure the transition goes smoothly, with no disruption in cash flow. The following steps should be considered as part of a comprehensive implementation plan:
- Begin by identifying the education needs of your staff: (1) who requires training; (2) what (type and level) of training do they require; and (3) when and how should they be trained.
- Plan a series of gradually more detailed educational programs over the next two and half years to transform your staff into ICD-10 experts. This education can be face-to-face, Internet-based, or be CD-ROM and/or book-driven. However, starting too soon to train staff on the specific new ICD-10-CM codes may be counter-productive. Many believe that detailed ICD-10-CM education should be offered to staff no more than six months before the compliance date for more effective retention.
- Train physicians by comparing their ICD-9-CM code with the new ICD-10-CM code and identifying what further information will be needed to report the diagnosis correctly under ICD-10-CM. This feedback will prepare physicians for providing coders the necessary information.
Robert TennantMGMA Government Affairs DepartmentEnglewood, Colo.Nancy EnosIndependently contracted MGMA consultantMGMA Health Care Consulting GroupEnglewood, Colo.
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