ICD-10 is Just Around the Corner. Are you ready?

We all knew it was coming. After years of pushing back the deadline, it’s official: On October 1st, 2014, health care practitioners and clinics have to start using the 10th Clinical edition of the International Classification of Disease (ICD-10).

Is your office ready for the switch? Is your software capable of the task? Do you have any idea how these codes differ from those you’ve been using and what the charting requirements are for them? Did you even know that there are new charting requirements for diagnostic coding?

I’m not here to worry you, but now is the time to start preparing if you haven’t already. If you don’t start thinking – learning and prepping now – I’m afraid you will be in a world of hurt come October of this year. This is not simply a matter of using a different code for your diagnosis. You need to update software and office forms, train your staff and – most of all – create a cash reserve. We are almost guaranteed to see a slow down in payer reimbursement after a switch to the new system. Software bugs, confusion on dates of service, coding inconsistencies, and slow-downs galore for reimbursement for services rendered will likely be part of the norm short-term.

Looking beyond the initial changes with implementation of ICD-10, you need to educate yourself and your staff on code structure, guidelines and code sets used most often in your office. Luckily, many coding guidelines are consistent between ICD-9 and ICD-10. It’s just a new edition after all – however, not all standard rules apply. For example, if a combination code exists, it is inappropriate to code two separate conditions, or multiple symptoms (i.e. there is a single code for Type 2 diabetes mellitus with mild non-proliferative diabetic retinopathy with macular edema, E11.321). In some cases, it is very similar to the summary of a chart note due to the level of specificity.

By comparison, the ICD-10 system has room for over 69,000 more codes than the 14,000 in the ICD-9 system. You must be far more specific in your diagnoses in order to code correctly, and you must chart the details as well. Why? As we move into the future, payers are likely to base pay and complexity upon which codes are used; as we move to global (outcome-based) care vs. fee-for-service (procedure-based), payment will likely require this increased amount of detail, both in charting and for any codes applied to a visit.

For example, if you see an asthmatic patient today, you can simply chart and code that they have asthma, unspecified (493.90). Following implementation of ICD-10 this October , physicians cannot arrive at an appropriate code without clarifying the severity of the ailment (i.e. mild-intermittent, moderate-persistent, etc.). Unspecified codes do exist, but using them too often may flag you to payers for auditing and the risk of being down coded or not reimbursed at all.

How do you prepare for these changes? If you do only one thing before October 1, 2014 (and I hope it is not), increase your cash reserve. This is to ensure that your clinic will be solvent during the transition in the event there are slow downs in reimbursement. You also need to start understanding ICD-10 structure – the rubrics, codes and, most importantly, the charting/documentation requirements that precede the coding. Most likely, this will also mean some edits to your current practice as far as updating forms and chart notes.

There are many online resources for this education, and the WANP is here to help as well. We plan to offer a series of three webinars on ICD-10 coding, with the first scheduled for Wednesday, March 12, from 6-8 pm, with recording available for those who can’t attend at that time. Discounted pricing will be available for WANP members.

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