ICD 10 Code

ICD 10 Code - Why we should be preparing now for the transition from ICD 9 to ICD 10 and the concerns to the medical billing specialist and coder. The transition from ICD-9 Codes to ICD 10 concerns me - and here's why.

Experience with NPI

Just judging by the adoption of NPI (National Provider Identifier) numbers and the challenges it presented to our billing service, ICD-10 code implementation has the potential to be very disruptive if a practice or billing service is not prepared.

And NPI was only ONE number - ICD 10 codes are much more complex. Even if you and your provider are prepared, what about clearinghouses and insurance payers? Not to mention that model of efficiency - Medicare!

When we incorporated NPI, we had the cost and disruption of upgrading our practice management software, coupled with having to re-map our claim files sent to the clearinghouse. There were also issues and confusion with certain payers regarding legacy number, group NPI, and individual NPI.

This resulted in many claims not getting paid on the first submission - or second - or third..... In some cases claims had to be re-submitted many times over. This was a major disruption to our client's revenues - and ours. And our clients are looking to us as a billing service to have all the answers.

As with NPI, we can expect that everybody will have a different interpretation of what implementing the new ICD 10 will require.

What are the Costs?
What will the cost be to my medical billing service? What will it cost my providers?

October 2015 looks like a long way off (it's 2013 when I write this) but we need to be planning and preparing for this transition now. I don't know if anyone has fully grasped how much this will cost in direct and in-direct costs.

By direct I mean costs in time and money for training, mapping ICD-9 to ICD-10, and potential costly software modifications. By indirect I mean costs in interruptions to reimbursement for a healthcare provider - especially small ones. I have a feeling this is another unfunded mandate resulting from the 1996 HIPAA legislation that's going to cost all parties involved.

What are ICD 10 Codes?
ICD-9 codes are nearly 30 years old and cannot be expanded any further diagnosis. Many of its diagnosis categories are full. ICD 9 codes are 3 to 5 characters. The first can be numeric or alpha, the 2nd through 5th are numeric with a decimal after the third character.

ICD 10 codes are 3 to 7 characters, the first one is alphabetic, 2nd through 7th are either alphabetic or numeric, with a decimal after 3 characters. These codes are arranged in chapters and sub-chapters with diseases grouped by letter. ICD 10 allows increased detail and the flexibility for emerging diagnosis. It is robust and has a logical structure with clear consistent definitions. It allows over 155,000 diagnosis codes compared to a maximum of 17,000 ICD 9 codes.

The greater number of codes in the ICD 10 will make it easier to find the right diagnosis code. ICD 10 has an improved structure and specificity; it should be easier to use than ICD 9. Most practices use a relatively small number of codes related to the type of specialty.

ICD 10 codes are organized in 22 chapters as listed below:

  • 1: A00-B99 - Certain infectious and parasitic diseases
  • 2: C00-D48 - Neoplasms
  • 3: D50-D89 - Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
  • 4: E00-E90 - Endocrine, nutritional and metabolic diseases
  • 5: F01-F99 - Mental and behavioral disorders
  • 6: G00-G99 - Diseases of the nervous system
  • 7: H00-H59 - Diseases of the eye and adnexa
  • 8: H60-H95 - Diseases of the ear and mastoid process
  • 9: I00-I99 - Diseases of the circulatory system
  • 10: J00-J99 - Diseases of the respiratory system
  • 11: K00-K93 - Diseases of the digestive system
  • 12: L00-L99 - Diseases of the skin and subcutaneous tissue
  • 13: M00-M99 - Diseases of the musculoskeletal system and connective tissue
  • 14: N00-N99 - Diseases of the genitourinary system
  • 15: O00-O99 - Congenital malformations, deformations and chromosomal abnormalities
  • 16: P00-P96 - Certain conditions originating in the perinatal period
  • 17: Q00-Q99 - Congenital malformations, deformations and chromosomal abnormalities
  • 18: R00-R99 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
  • 19: S00-T98 - Injury, poisoning and certain other consequences of external causes
  • 20: V01-Y98 - External causes of morbidity and mortality
  • 21: Z00-Z99 - Factors influencing health status and contact with health services
  • 22: U00-U99 - Codes for special purposes

Part of HIPAA
HIPAA legislation included the requirement for use of ICD 10 with a compliance date of October 1, 2013 for implementation. The government agency requiring implementation is the Department of Health and Human Services (HHS). HHS has no plans to delay implementing.

Related to the switch to ICD 10 is the transition to the version 5010 standard for electronic transactions effective January 1, 2012. The 5010 changes are necessary to accommodate ICD 10 codes and NPI.

ICD-9 will no longer be maintained after implementation of ICD 10. ICD 10 is currently in use by other countries and is updated annually just like ICD 9.

ICD 10 Code Concerns
The issues that concern most providers and billing services are the potential economic impact. Will practice management systems be able to accommodate the greater number of diagnosis codes (up to 155,000) for ICD 10? Software applications from the front end physicians office to the clearinghouse to the payer will have to be able to accommodated ICD 10.

Will payers that don't yet use ICD 10 codes map everything back to ICD 9 for processing?

Another complication is that some ICD 10 codes are unique to the encounter. So the initial patient visit may use one ICD 10 code while subsequent visits will require another.

Estimates for healthcare providers, coders, and billers to become proficient with ICD 10 is 6 months.

Fraud & Waste?
Henry Percy wrote an interesting blog piece recently called "War against Doctors". He raised a very good point regarding the 70,000 new diagnosis codes to be introduced as a part of ICD-10. He contends there will be a whole new round of seminars put on by consultants on how to maximize revenue and game the system through "proper" coding. 

Contributing to this is the Medicare practice referred to as "Pay and Chase". This is where a provider is paid, and later chased down for a refund if an error or fraud has been determined. As you can imagine it's more difficult to recoup the payment after it's been made. 

CMS Mapping
CMS and CDC have developed a crosswalk (or mapping) tool from ICD-9 to ICD 10-CM/PCS diagnosis codes for use by all payers and providers. It's available at the
CMS Website.

I'm not saying ICD 10 is a bad thing, I'm just very concerned about the impact it will have on health care reimbursement.

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