Home Health & Hospice Week

Get comfortable with the guidelines and format now, not later.

With a myriad of reimbursement and regulatory challenges on your plate, preparing for ICD-10 is probably the last thing you want to think about.

Training for the ICD-9 to ICD-10 transition can easily slide to the bottom of your to-do list since D-day for compliance isn’t until Oct. 1, 2014. But experts recommend you at least get your feet wet now. Take the transition in bite-size pieces starting now, and you’ll flow into the new code set more easily than you expected.

Before you begin: Make sure you’re learning the right code set. You’ll see references to both ICD-10-CM and ICD-10-PCS. For diagnosis coding, you’ll use ICD-10-CM. “ICD-10-PCS is a completely different coding system and designed for hospital inpatient procedures,” points out coding expert Kathy DeVault, director of HIM Solutions for AHIMA.

Whatever you do, don’t save your ICD-10 training until the last minute. If you’re unsure of where to start, get an ICD-10 book and begin browsing the codes to get a feel for them and their format, DeVault suggests. You may be surprised at the similarities to ICD-9. “People often say the new code system wasn’t as scary as they expected,” she says.

Good idea: Take the ICD-10 coding guidelines and assign a chapter to each person on your team, DeVault suggests. Have them discuss and compare the differences from ICD-9. Then you can start to narrow down what’s significant to your setting, she says.

Send at least one person from your office now for ICD-10 training and have him or her report back the impact of the transition, recommends Joanne Byron, a Certified ICD-10 Training In-structor with the American Institute of Healthcare Compliance (AIHC), based in Medina, Ohio. If you don’t use electronic health records or computer-aided coding software, it’s even more important to get a head start on training, she notes.

Understand Basic Navigation of ICD-10

From the starting gate, you’ll find that the ICD-10-CM guidelines are similar to those of ICD-9-CM. You’ll also find familiarity in the code lookup system. “The condition is referenced in [an] alphabetical index, then confirmed in the tabular,” Byron says.

Key Difference: The main ICD-10 categories are grouped by letter, not number. For example, nervous system diseases make up the G category, diseases of the eye and ear make up the H category, and diseases of the circulatory system make up the I category, etc. These categories, however, break down into more specific alphanumeric codes.

You will also find a larger breakdown of code choices for a disease/condition in ICD-10. This is known as “increased granularity,” Byron explains. In addition, “some of the codes must be completed with 6th and 7thcharacters when referencing the tabular index,” she adds. This is a new concept, as ICD-9 codes only extend up to 5 characters.

Glam Up Your Transition Experience With GEMs

Take advantage of General Equivalency Mappings (GEMs), which you can find for free on CMS’s website at www.cms.gov/Medicare/Coding/ICD10/index.html. In a nutshell, GEMs are a system that helps you translate between ICD-9 and ICD-10.

 “Using GEMs is a good place to start re-garding codes you use most often in ICD-9 and what your coding choices will be in ICD-10,” Byron says. You can also purchase GEMs reference books or mapping software, she adds.

GEMs, however, are not a “simple crosswalk,” CMS explains in its GEM guide. “The GEM files attempt to organize [the] differences in a meaningful way, by linking a code to all valid alternatives in the other code set …”

Don’t be surprised: Because ICD-10 has increased granularity and more character extensions, etc., one ICD-9 code can map over to hundreds of new codes in ICD-10 for the same condition, Byron points out.

Resource: You can purchase features such as an ICD-10 crosswalk and code lookup with your Eli’s Home Care Week subscription at www.super coder.com.