Countdown to ICD-10

The Wall Street Journal published an amusing article about the specificity of injury code descriptions in ICD-10 (9/12/11).  The article was entertaining.  It avoided all mention of the serious policy reasons behind the switch from ICD-9 to ICD-10 and the cost to the health care system of implementing it.  There was no mention of the potential chaos of denied claims, non-specific diagnosis codes or computer systems that might be unable to handle seven digit diagnosis codes.  Not to mention possible cash flow disruptions.

Physicians, managers, billers and coders are all worried about the transition.  Large health care systems are already months into planning, meetings, time lines and budget allocations.  What should physician groups be doing to prepare, and when?  Should training start in 2011? 2012? Or wait until the last minute?

First, here are a few facts.  Claims submitted for dates of service on and after October 1, 2013 will use ICD-10 codes.  Claims submitted for dates of service on and before September 30, 2013 will use ICD-9 codes.  Which codes are used will depend on date of service, not the submission date of the claim.  Physician practices will continue to use CPT® codes to describe the procedures performed, but will use ICD-10 codes to describe the medical necessity for the service or the condition or symptoms of the patient.  The number of diagnosis codes will increase from about 14,000 to about 69,000 codes.  The coding will require greater specificity to select the correct code.  Some injury diagnosis code will also include whether this service was the first encounter, a subsequent encounter or a long term after effect of the injury.  Laterality is described for some conditions.  Stable or unstable is described for some conditions.  All in all, the medical record documentation will need to be more specific, and the person selecting the ICD-10 code will need more clinical knowledge than when selecting ICD-9 codes.

Groups that are using older versions of their software program will need to upgrade to the latest version of their software.  Software vendors will be busy right before the transition.  It would be prudent not to wait until the last minute to upgrade your software.  Stay up to date on the latest version, so that the transition before October 1, 2013 will be easy.

When should someone start training?  That depends on the size of the practice.  Training programs could be sold out in the spring and summer of 2013, although I expect commercial vendors will try to accommodate everyone.  In general, staff members and coders should learn first, and clinicians should learn closest to the October 1 implementation date.  If the group is large enough, then train someone who can train everyone else in 2012 or near the end of 2012.  Coders without a strong clinical background should consider taking Anatomy and Physiology prior to learning ICD-10.  And be prepared to research clinical conditons that are unfamiliar.

Buy an ICD-10 book now.  Although it is still in draft form, it is important to become familiar with the resource and the specificity of it now.  It is available from many coding vendors or on Amazon.  Print out a list of the 30 most commonly used diagnosis codes in your group, and try to code them in ICD-10.  This will uncover when more specific documentation is needed or what clinical areas the coder needs to learn about.

Watch Nancy Maguire’s training on Codapedia.  These are available for free to registered users, and can be watched over and over again.  She does a terrific job explaining the general principles, and then the specifics of each chapter.  There are 36 in all, one each month until September of 2013!  The first twelve on a single CD will be available to purchase at the MGMA meeting in October of 2011, and on the Codapedia website after that.  The second year will be available April 1, 2012 and the third and final year will be available October 1, 2012, a year before the implementation date. 

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