Getting Ready for 2014 and ICD-10

May 1, 2013
Betsy Nicoletti

ICD-10 diagnosis codes are effective Oct. 1, 2014. Set an implementation budget and timeline. Identify ICD-9/ICD-10 differences. Say goodbye to nonspecific codes.

It's official. In the spring of 2014 Jimmy Fallon will move "The Tonight Show" to New York City. The World Cup will return in the summer. And in the fall, healthcare providers will see a significant change as claims for services provided on or after October 1, 2014, will need to use ICD-10-CM diagnosis codes. Hospitals will also use ICD-10-PM codes to report procedures, but physicians will continue to report CPT codes for the services they provide. Do you want to have time to watch Jimmy in the spring and catch a few World Cup games in the summer? If so, you need to prepare for ICD-10 now.

Medical practices that don't prepare for ICD-10 will have more negative consequences than missing Brazil in the finals (you heard it here first). Unprepared practices risk decreasing provider productivity in the last quarter of 2014 as clinicians search for a diagnosis from the 70,000 possible codes. Coding queries between coders and clinicians will skyrocket, further burdening clinical staff and delaying the payment of claims. Incomplete, inaccurate, and incorrectly sequenced diagnosis codes could result in delayed or denied claims. And if anyone tells you how payers will process nonspecific ICD-10 codes in 2014, ask them to send their crystal ball my way - I've been meaning to ask "Will I find true love?"

Drive out nonspecific codes

Since there are about 14,000 ICD-9 codes and 70,000 ICD-10 codes, ICD-10 must be more specific. Increasing the specificity of current diagnosis coding will decrease the pain of the transition. Run a list of your 100 most commonly used diagnosis codes and identify the nonspecific codes. What is the source of these codes? Are they on a paper encounter form? A favorite list in the EHR? Are they simply the easiest codes to use for the clinician, or all that can be supported based on the clinical documentation? One cardiology practice I worked with was using all nonspecific myocardial infarction codes for their hospitalized patients. The physicians knew precisely the type and location of the MI, but they did not write that information on the charge slip. The coders used the charge slip - no, the cath report - to select the code. Identify the reason your group is using nonspecific codes and substitute a process that selects more specific codes.

Look at mappings between ICD-9 and ICD-10 codes

CMS has developed General Equivalency Mappings (GEMS) to translate coding policy and coverage determinations.  They are not intended to be a crosswalk for coding purposes. However, these translations are available and will help you improve your clinical documentation today, which will result in improved ICD-10 coding tomorrow. (Okay, 2014). Take for example breast cancer code 174.9. Using a code mapping program, 174.9 would provide "unspecified site of unspecified female breast."  Looking at the detail required to specifically code malignant neoplasm of the female breast, a coder would find that the specific site of the breast, or overlapping sites, and laterality is required to code this condition in ICD-10.

Set a budget and a timeline

Large groups and hospital systems did this months ago, and will be well serviced by their preparation in 2014. Smaller groups may have gotten off track when the implementation was delayed from 2013 to 2014. What should a group do now? Here's a quick list:

• Coders who do not have a background in anatomy and physiology should take a course;

• Buy an ICD-10 book and attempt to code the 50 most common codes in your practice;

• Look at translation programs (icd9data.com and icd10data.com) and enter your most common diagnosis codes - from the results of your comparisons, make a list of clinical documentation improvements that will be required;

• Select certain coders in your practice to go off-site for two-day training. In a small practice, that may be just one employee, but be aware that leaves the group vulnerable if the employee leaves the practice; and  

• Develop a timeline for training clinical staff close to the implementation date.

One final piece of advice: Read the general guidelines for coding ICD-10-CM. These are at the front of the book and on the CDC's website.  The guidelines have some differences from ICD-9 but are also comfortingly familiar. There are terms and conventions used in both coding systems that will be familiar to experienced diagnosis coders.

CMS has indicated that it fully intends to implement ICD-10 in 2014. Get started now, and you'll have time to watch Brazil win the World Cup.

Betsy Nicoletti is the founder of Codapedia.com. She is the author of "A Field Guide to Physician Coding." She believes all physicians can improve their compliance and increase their revenue through better coding. She may be reached at betsy.nicoletti@gmail.com or 802-885-5641.