ICD-10 Is Here: Are You Ready?

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ICD-10 has benefits but will likely present challenges as physicians transition.
ICD-10 has benefits but will likely present challenges as physicians transition.

Oct. 1, 2015, marks the official compliance date for implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10) by Centers for Medicare and Medicaid Services (CMS), the first update to the standardized codes for medical conditions and procedures in over 35 years. The newly expanded codes — jumping from 14,000 to 69,000 — will grant healthcare professionals greater specificity and clinical accuracy for noting procedures and diagnoses, but could also present obstacles and headaches in the transition from the previous ICD-9 codes.

What's Changed With ICD-10?

After delaying the implementation deadline several times, the new ICD-10 code set will allow for greater measurement of patient outcomes and care, along with improved clinical decisions for healthcare providers. Besides the expansion in the number of codes for procedures and diagnoses, some of the most significant changes are noted below:


                          Source: CMS.gov

Medicare claims processing systems will not accept ICD-9 codes for dates of services after Sept. 30, 2015, and will not accept claims that include both ICD-9 and ICD-10 codes. However, CMS and the American Medical Association (AMA) agreed to a 1-year grace period in which Medicare claims will not be denied based on which diagnosis code was selected, as long as an ICD-10 code from an appropriate family of codes is submitted; the family of codes is considered the same as the ICD-10 three-character category. For example, if a patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus) under ICD-10, use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) would likely not prompt an audit during the 12-month grace period.

Steps to Take If You're Not Prepared

As clinicians prepared to transition, the AMA offered the following advice:

  1. Call your vendors immediately: ask about any updates needed immediately and how to address issues after Oct. 1.
  2. Get your staff trained quickly: CMS and the AMA offer a variety of resources, some of which are specialty-specific.
  3. Focus on your top 10-15 diagnosis codes: Rhonda Buckholtz, vice president of ICD-10 education and training for the American Academy of Professional Coders, recommends creating a practice management report to determining the top diagnoses with ICD-10.
  4. Acknowledgement reports: watch acknowledgement reports closely after claims are submitted to spot issues immediately.
  5. Establish cash reserves: if possible, have cash reserves on hand or look into lines of credit should payment get interrupted and you need them.

Online Conversion Tool

To help healthcare professionals with this transition, Endocrinology Advisor's sister site, MPR, has partnered with ICD-10 Charts to offer a free interactive ICD-9 conversion tool and reference charts covering the most commonly used codes by therapeutic area. Users can search all codes and descriptions, by ICD-9 or ICD-10 code, or by code groups/categories and create custom charts on the ICD-10 website.


Better Codes, Better Patient Care

While there may be frustrations and hurdles in the transition period, these new codes will ultimately help clinicians and healthcare professionals in providing more precise and specific snapshots of patient care and management. As healthcare shifts from fee-for-service to a value-based payment system, implementing these codes quickly and efficiently is imperative.

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