Alleviating ICD-10 concerns, what you need to know
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CMS issued its final rule Jan. 16, 2009, marking Oct. 1, 2013, as the compliance date for facilities to transition from ICD-10-CM (clinical modification) and ICD-10-PCS (procedure coding system), but most facilities are left questioning the implications of the transition.
Sue Bowman, RHIA, director of coding policy and compliance at the American Health Information Management Association (AHIMA), said that coding experts should not fear the transition as ICD-10 will modernize the outdated 30-year-old coding classification systems to better measure quality, gain better reimbursement and add greater specificity to the system.
"The general coding process is very much the same,” explained Bowman.
When comparing the structures of the two code sets, for the most part they are similar, according to Bowman, but rather than using numeric characters and having three to five digits like ICD-9-CM, ICD-10 diagnosis and procedure codes are alphanumeric with three to seven characters.
The switch from ICD-9 to ICD-10 will deploy almost 155,000 codes compared to more than 17,000 code sets. The final figure includes both diagnostic and procedural coding, as ICD-9-CM employs 14,025 diagnostic codes and ICD-10-CM will utilize 68,000-plus diagnostic codes. In addition, procedural codes will jump from 3,824 in ICD-9 to 72,589 codes in ICD-10-PCS. According to Bowman, ICD-10-CM codes add specificity and have more complete titles so there is no need for coders to have to refer back to a subcategory or sub-classification level in order to determine the meaning of the code.
Additionally, ICD-10-CM adds laterality to classify the side of the anatomy affected by the condition and also expands the use of combination codes that include conditions and associated common symptoms or manifestations. The greater specificity, said Bowman, will reflect modern medicine and medical terminology such as new technologies, medicines and diseases.
Afraid of change? Clearing up the unknown
Bowman noted many myths that have made coders and healthcare professionals uneasy about the transition into ICD-10-CM. However, she offered that in reality, “because ICD-10-CM is much more specific, is more clinically accurate and uses a more logical structure, it is much easier to use than ICD-9-CM.”
She said that electronic hardware is not necessary for implementation, like some may think. “Just as with ICD-9 codes, there will be encoders and other electronic tools available to expedite the coding process,” but ICD-10 codes are “not predicated on the use of electronic hardware and software.”
Additionally, she said that the increased number of ICD-10 codes compared to ICD-9 will not make the process more complex. “Just as the size of a dictionary doesn’t make a dictionary more difficult to use, a higher number of codes doesn’t increase the complexity of the codes,” she explained. “In fact, greater specificity makes it easier to find the right code.”
Even without improved documentation, Bowman said that improvements in data will occur because ICD-10-CM detail is already contained in medical record documentation and is just not utilized because it is unnecessary for ICD-9-CM.
Getting a head start on new transitions
Bowman said that facilities should start anticipating the transition to ICD-10-CM prior to the compliance date.
She suggested that facilities begin assessing and improving their documentation by reviewing the most commonly coded conditions at their facilities and comparing them to ICD-10-CM codes for the same conditions.
She said that AHIMA suggests that training begin for coding professionals six to nine months prior to the cutoff date for ICD-10-CM implementation. “Providing the right training at the right time is necessary to ensure that there is sufficient time for learning and to avoid retraining,” she explained.
Bowman said the first step is to begin individual assessments on coding professionals that can identify certain areas of strength or weaknesses. This will help to customize training tools and resources as the deadline gets closer.
Because ICD-10-CM has the same hierarchical structure as the prior coding system, AHIMA expects that two days of training—six hours for understanding the coding structures, six hours of intensive training applying ICD-10-CM coding guidelines and four hours practicing applying ICD-10-CM to common encounters in a facility—should be sufficient for experienced coders. However, for those completely unfamiliar with coding systems, this process will take longer—approximately 50 hours.
“More detailed documentation will result in a more accurate clinical picture and better data for supporting the many purposes for which coded data are used today as well as the uses for ways that coded data will be used in the future,” concluded Bowman.
More information about the transition to ICD-10 is available at the AHIMA web site.