Are you ready for ICD-10?
Physicians—and those of us who work with them—are dealing with a lot of changes in how we’ll handle billing, health records and claims. The biggest of these changes is the new ICD-10 diagnostic coding system.
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, a medical classification list by the World Health Organization (WHO). The codes describe diseases, symptoms, causes and more and are used on claims for public and private payers. ICD-10 improves on the currently used ICD-9 with new codes to better describe medical diagnoses and procedures.
Clinical documentation is necessary for medical coders and other health industry workers. The American Health Information Management Association has endorsed ICD-10, maintaining that it benefits national payment and quality reforms. It also said that ICD-10 is long overdue; ICD-10 is already the medical industry standard in almost every country in the world.
In August, the Centers for Medicare and Medicaid Services (CMS) postponed the compliance date for ICD-10 to Oct. 1, 2014. The agency opted for the one-year delay in lieu of bypassing ICD-10 altogether and waiting to adopt ICD-11.
“We believe a delay in the ICD-10 compliance date will increase the readiness of the industry at large, and thus avoid a large disruption in health care claim payments,” the ruling stated.
The American Medical Association (AMA) isn’t all that happy about ICD-10, even with the new compliance deadline.
AMA says the 2013 deadline fails to take into account the costs associated with transitioning from ICD-9 to ICD-10. These costs include training for office staff and physicians as well as upgrading health-information software and hardware. AMA says compliance costs could reach $2.7 million for larger practices.
AMA had lobbied for ICD-10 postponement by two years (to Oct. 1, 2015). The largest association of medical professionals in the United States says ICD-10 will make processing claims payments cumbersome and time-consuming. One example given was a fractured kneecap; whereas a physician has two codes under ICD-9, there are 480 codes using ICD-10.
Everyone covered by HIPAA will be required to conduct transactions using ICD-10 codes, including providers and payers who do not deal with Medicare claims. The new codes don’t affect Current Procedural Terminology (CPT) coding for outpatient procedures; they are for hospital inpatient procedures only.
Current ICD-9 codes are mostly numeric and have three to five numbers. ICD-10 codes are alphanumeric and contain three to seven characters. Like ICD-9 codes, ICD-10 will be updated every year.
CMS is hosting free national teleconferences to help providers prepare for the change from ICD-9 to ICD-10. CMS suggests that doctors ask their payers the following questions in order to avoid payment disruptions:
- Are you prepared to meet the ICD-10 deadline of October 1, 2014? Where is your organization in the transition process?
- Who will be my primary contact at your organization for the ICD-10 transition?
- Can we set up regular check-in meetings to keep our progress on track?
- When will you be ready to accept test transactions from my practice?
- What will we need to test with you?
- Do you anticipate any changes in policies or delays in payments to result from the switch to ICD-10?