What You Should Know About ICD-10-CM Codes

Author(s): 
Barbara Aung, DPM

   The ICD-9-CM code conveys the category of code as well as the etiology, anatomic site and manifestations. The ICD-10-CM code will cover the category of code as well as the etiology, manifestation and severity along with an extension.

   General equivalence mappings can assist in converting a code in ICD-9 to ICD-10. However, there may not be a direct one-to-one translation of codes from ICD-9 to ICD-10.

   Let’s look at a few examples (see “Comparing ICD-9 to ICD-10 For Common Diagnoses” at right)

   As you can see from the examples provided, we will have a learning curve as we switch to the ICD-10-CM codes. This will require that we train all of the staff involved in billing, coding and contracting, and we will need to review our current business practices as well as we move to the new system. It is not as simple as memorizing new set of diagnosis codes.

A Checklist For Implementing ICD-10-CM

I offer a to-do list that I am using to develop my ICD-10 implementation plan. I believe this list has helped me to stay organized and I feel I can complete the transition without last-minute anxieties.

   1. Organize a team to lead the process. I will be meeting with my billing supervisor and practice administrator once a month to stay focused and meet set deadlines.

   2. Assess the practice’s business and clinical impact. Identify areas of business that will be impacted, whether the patient flow will be impacted and if there will be a loss of productivity.

   3. Start discussions with software vendors to implement or update electronic health records (EHR) and practice management systems. Test the systems before the “go live” date. Remember that there will be an overlap period in which you will need parallel systems to handle both ICD-9 and ICD-10. Can your vendors and hardware handle the needs of the dual systems?

   4. Are there documentation gaps or other gaps within the practice? These include the time you will need to set aside for training necessary staff on codes and documentation needs.

   5. Develop timelines with “due dates.” Identify targets or markers of success and forward progress. Hold specific staff responsible for specified tasks.

   6. Have a training plan and train everyone involved or impacted in phases. This is particularly import for physicians as we are often the ones to show more resistance. Realize that training will have a financial component in either purchasing training and/or time that the office is not producing income when staff is training.

   7. Work out a budget to get the transition complete on time. You may need to upgrade or purchase software as well as hardware. Training will incur a cost as will any new forms and documentation processes that will need to change.

   8. Discuss and review contracts with payers and vendors. Make sure they will be ready to meet their obligations and that you will not be penalized should the contract language not provide protection for you or is only one-sided. One of the biggest questions that I came up with during this review process is whether my contracted insurance company will be ready to receive claims using the ICD-10 codes and how it will deal with claims submitted the day before the implementation date should these claims require appeals or resubmissions. Also, do the practice management and EHR vendors have a plan for the conversion and how much of the cost will they pass off to you? You will need a parallel system for at least one year from implementation to deal with older claims. Keep this in mind.

   9. Review practice workflow and business processes. Take a look at charge tickets (superbills), fee schedules and other business forms that may require updating.

   Although this may seem like a daunting task, it appears we now have an additional 24 months to get this done. The old saying of how do you eat an entire elephant — one bite at a time — seems most appropriate for the task at hand. If we have a plan and we work the plan in small bites each week, month and year, we should be ready to hit the starting line — or in this case, the finish line — running rather than trying to leap a massive distance in a single bound.

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