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11 myths busted about ICD-10 implementation

From the October ACP Internist, copyright 2013 by the American College of Physicians

By Debra Lansey

After the U.S. Department of Health and Human Services (HHS) mandated the use of ICD-10, several myths sprang up about the coding system, which includes both diagnostic and procedural codes. In this column, we’ll run through some of the most widespread fictions to get to the truth.

1. Myth: ICD-10 implementation planning should be undertaken with the assumption that HHS will grant an extension beyond the Oct. 1, 2014, compliance date.

11 myths busted about ICD-10 implementation

Facts: All entities covered by the Health Insurance Portability and Accountability Act (HIPAA) must implement the new code sets with dates of service, or dates of discharge for inpatients, that occur after Oct. 1, 2014. HHS has no plans to extend the compliance date for implementation of ICD-10; therefore, covered entities should plan to complete the steps required to implement ICD-10 by the deadline.

2. Myth: Entities that use ICD-9 and are not covered by HIPAA, such as workers’ compensation, liability, and auto insurance companies, will choose not to implement ICD-10.

Facts: Because ICD-9 will no longer be maintained after ICD-10 is implemented, it is in those noncovered entities’ best interests to use the new coding system. The increased reporting detail in ICD-10 will be of significant value to noncovered entities. The Centers for Medicare & Medicaid Services (CMS) has been working with noncovered entities to encourage their use of ICD-10.

3. Myth: State Medicaid programs will not be required to update their systems to use ICD-10 codes.

Facts: HIPAA requires the development of one official list of national medical code sets for health insurers. CMS will work with state Medicaid programs to ensure that ICD-10 is implemented on time.

4. Myth: The increased number of codes in ICD-10 will make it impossible to use.

Facts: You will find that most of the new ICD-10 codes will not apply to your practice. Think of an old phone book. There may have been thousands of telephone numbers listed, but how many did you really use? Your use was limited to those that were relevant to your life. Just as you didn’t need to search the entire list of ICD-9 codes for the proper code, you also won’t have to search through the entire list of ICD-10 codes.

An alphabetic index and electronic coding tools are available to help you select the proper code. Because ICD-10 is much more specific, is more clinically accurate, and uses a more logical structure, it may actually be easier to use than ICD-9. Most physician practices will use a relatively small number of diagnosis codes that are generally related to their medical specialty.

5. Myth: ICD-10 was developed with input only from administrators and accountants.

Facts: The development of ICD-10 involved significant clinical input from physicians and other health care professionals. Several medical specialty societies contributed to the development of the coding system.

6. Myth: There will be no hard-copy ICD-10 and ICD-10-PCS code books available. When ICD-10 is implemented, all coding will need to be performed electronically.

Facts: ICD-10 and ICD-10-PCS code books are already available and are a manageable size, again similar to a phone book or to a decently sized dictionary, rather than the eight or nine volumes that have been rumored. The use of ICD-10 is not predicated on the use of electronic hardware and software.

7. Myth: Unnecessarily detailed medical record documentation will be required when ICD-10 is implemented.

Facts: As with ICD-9, ICD-10 codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for use when documentation doesn’t support a higher level of specificity. Much of the detail contained in ICD-10 is already in medical record documentation but is not currently needed for ICD-9 coding.

8. Myth: ICD-10-based “superbills” will be too long or too complex to be of much use.

Facts: Practices may continue to create superbills that contain the most common diagnosis codes used in their practice. ICD-10-based superbills will not necessarily be longer or more complex than ICD-9-based superbills. Bear in mind that neither currently used superbills nor ICD-10-based superbills can provide all possible code options for many conditions. If you decide to use superbills, conduct a review that involves removing rarely used codes and cross-walk common codes from ICD-9 to ICD-10, which can be accomplished by looking up codes in the ICD-10 code book or using the General Equivalence Mappings (GEMs).

9. Myth: The GEMs were developed to provide help in coding medical records.

Facts: The GEMs were not developed to provide help in coding medical records. Code books are used for this purpose. Mapping differs from coding in these ways:

  • Mapping links concepts in two code sets without consideration of patient medical record information; and
  • Coding involves the assignment of the most appropriate code based on medical record documentation and applicable coding rules/guidelines.
  • The GEMs can be used to convert the following databases from ICD-9 to ICD-10: payment systems, payment and coverage edits, risk adjustment logic, quality measures, and a variety of research applications involving trend data.

10. Myth: Each payer will be required to develop its own mappings between ICD-9 and ICD-10 because the GEMs developed by CMS and the Centers for Disease Control and Prevention (CDC) are for Medicare use only.

Facts: The GEMs are a crosswalk tool that was developed by CMS and the CDC for the use of all clinicians, payers, and data users. The mappings are free of charge and are in the public domain.

11. Myth: Medically unnecessary diagnostic tests will need to be performed to assign an ICD-10 code.

Facts: As with ICD-9, ICD-10 codes are derived from documentation in the medical record. If a diagnosis has not yet been established, you should code the condition to its highest degree of certainty (which may be a sign or symptom) in both coding systems. In fact, ICD-10 contains many more codes for signs and symptoms than ICD-9, and it is better designed for use in ambulatory encounters when definitive diagnoses are often not yet known. Nonspecific codes are still available in ICD-10 for use when more detailed clinical information is not known.

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Last major updates done for ICD-9, ICD-10

The last major update of ICD-9 took place on Oct. 1, 2011. Any further revisions to ICD-9 will only be for a new disease and/or a procedure representing new technology.

The last major update of ICD-10 until Oct. 1, 2015, also took place on Oct. 1, 2011. Between Oct. 1, 2011, and Oct. 1, 2015, any revisions to ICD-10 will be for new diseases/new technology procedures, and any minor revisions will correct reported errors in these classifications.

Regular (at least annual) updates to ICD-10 will resume on Oct. 1, 2015.

The implementation deadline for ICD-10 remains Oct. 1, 2014. There is no indication that there will be another delay; in response, ACP’s position is to provide its members with information and resources to help them prepare for the coding transition. You will find our ICD-10 resources online.

It’s important to continue to make progress toward implementation of ICD-10. It’s only one year away. To assess whether your practice is on track for implementation, please check your progress against the ACP Physician and Practice Timeline, online.

From now through the end of the year, you should continue contacting your vendors to begin internal testing and validation in order to be sure ICD-10 will work in all aspects of your practice/facility. Specifically, you should focus on these tasks:

  • Contact payers to schedule testing and determine reimbursement policies;
  • Develop contingency plans in case testing and validation fail or in case other problems occur prior to “go live” implementation; and
  • Develop a budget for training and software upgrades.

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