Home Health & Hospice Week

Diagnosis Coding:

DON'T DELAY IN ICD-10 PREPARATION

Published on Tue Jan 06, 2009

You have an extra few years, but you'll still be hard pressed to achieve compliance.

Health care providers are claiming victory on the ICD-10 implementation schedule, but that shouldn't prevent you from planning for the transition already.

The Centers for Medicare & Medicaid Services extended the ICD-10 deadline by two years to Oct. 1, 2013 (see Eli's HCW, Vol. XVIII, No. 4, p.31), and providers and their coders are thrilled.

The delay from the proposed 2011 deadline "is a victory for medicine," says the Tennessee Medical Association in a typical response. "Everyone will have more time to become trained in the use of ICD-10 and make any intra-office systems changes necessary for implementation of this unfunded mandate," TMA says in a release.

"This delay is a victory for providers, payers, and coders," says the American Academy of Pro-fessional Coders in a release. It "allows for a more efficient transition, giving the proper amount of time to implement system and coding changes without impacting ... daily operations."

The National Association for Home Care & Hospice had called for CMS to delay ICD-10 until at least 2012, the trade group notes.

Not everyone is happy with the change, though. The American Health Information Management Association "was sorry to see the compliance deadline extended to ... 2013," the group says. "This further extension means more years without the data needed to make intelligent data-driven decisions related to all aspects of healthcare."

Get going: "This extra time gives the industry no excuse for an adequate implementation and compliance," AHIMA says. "The extra time should be used wisely and the industry needs to start now and not wait."

The year 2013 may seem far away, but billing and coding expert Steve Verno advises providers to begin preparing for ICD-10 now.

"Contact your software vendors to find out when updates will be available," he says. "Contact your insurance companies to find out when they will be ready so there's little interruption with the claims and payment process. Seek assistance from the coding and billing associations. We have work to do to get ready."

NAHC urges CMS to begin educating providers on the new system right away.

Delay unlikely: The ICD-10 final rule falls under the directive from the Obama administration to hold all recent Bush administration-issued regulations for review. But observers expect the ICD-10 regulation to proceed as planned, considering its relatively distant implementation date.

Get Ready For 155,000 Codes

CMS views ICD-9-CM as outdated because of the system's limited ability to accommodate new procedures and diagnoses within the established hierarchy of the coding system. ICD-9 is 30 years old and "obsolete," NAHC points out.

ICD-9-CM contains only 17,000 codes; Volume 3 (which contains the hospital inpatient procedure codes) has been running out of space for several years, resulting in placing procedure codes outside the clinical hierarchy where they belong.

ICD-10, by contrast, contains more than 155,000 codes and can accommodate a host of new diagnoses and procedures. The additional codes will also help facilitate the implementation of electronic health records.

The expanded diagnoses shouldn't scare coders and providers away, but they should be wary of a few things.

"A trained coder will not have any problem with the transition," Verno says. "The main issue we will face will be with provider documentation. Under ICD-9 we could use many unspecified codes, but not under ICD-10. The documentation must be more thorough and complete."

CMS says adoption of ICD-10 is expected to:

• More accurately define services and provide specific diagnosis and treatment information;

• Provide the precision necessary for a number of emerging uses such as pay-for-performanceand biosurveillance (monitoring information to help detect an emerging epidemic);

• Support comprehensive reporting of data;

• Ensure more accurate payments for new procedures, decrease the number of rejected claims, facilitate improved disease management, and coordinate disease monitoring and reporting worldwide; and

• Allow the U.S. to compare its data with international data to track the incidence and spread of disease and treatment outcomes.

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