Home Health ICD-9/ICD-10 Alert

Home health coders take a wait-and-see approach to preparation.

While there's still plenty of time to prepare for the ICD-10 transition, the Centers for Medicare & Medicaid Services began laying some groundwork during its May 19 Open Door Forum on the topic.

For instance: The implementation date for ICD-10 remains Oct. 1, 2013, but after that date, carriers will accept ICD-9 codes for services with dates of services prior to Oct. 1, 2013 "for a period of time," noted Pat Brooks, senior technical advisor with CMS, during the call. However, CMS has not revealed how long after the ICD-10 implementation date it will accept those codes.

Safe bet: "For a period of time" probably indicates a short duration, so the best plan of action will be to submit claims for services provided prior to Oct. 1, 2013 and coded with ICD-9 codes as quickly as possible to make certain they are processed in time.

Mapping resources: CMS provided a quick tour of its ICD-10 mapping system, which is posted on its Web site. The crosswalk, known as "general equivalency mappings" or "GEMs," will help agencies convert the existing ICD-9 codes to the new ICD-10 codes, and vice-versa.

One listener asked the CMS officials how big a role their software will play in converting ICD-9 codes to ICD-10.

Brooks noted that it's unclear whether software vendors will offer conversion products but suggested that those interested in converting large numbers of codes from ICD-9 to ICD-10 could automate the conversion on their own using the CMS GEM User's Guide as a resource.

"If you had a smaller project, a list of only 20 or 30 codes you personally wanted to convert, you probably could manually use the GEMs and make that conversion and check that in your books as well," Brooks said.

Another caller from a home health agency asked whether CMS would configure the crosswalk to work on Palm-type systems. Nurses in the field aren't near a computer to access the CMS site crosswalk files -- they carry Palm devices with them instead, the caller pointed out.

Brooks could only speak to the resources CMS has already created but said she wouldn't be surprised if vendors created additional applications.

However, "these GEMs aren't something that you'd want to carry around and just routinely code from; you'd want to code from the actual code book itself.

But as an additional tool, and another document, it may be that vendors will use this as a tool to make some kind of large conversion easier," she said.

In general, home health coders seem to be taking a relaxed approach to preparing for the ICD-10 conversion. Dipping their toes into ICD-10 audioconferences and articles seems to be a common approach for home care coders.

"I'm a fast learner, and I don't have a lot of time. As the transition time gets nearer, I will get serious about learning them," says coding and billing specialist Vonnie Blevins, HCS-D with Houston, Texas-based Excellence Healthcare.

Voicing concerns: "Coding will be slower with ICD-10 because the volume of codes precludes the use of coding manuals, so I will be using an encoder for code selection," says Chuck Berning, RHIA, HCS-D, with Sharp Home Care in San Diego, Calif. "Considering the length and specificity of the new codes, I will no longer be able to fill in codes from memory as many of us do now," he says.

Clinicians will need more training before the conversion as well, Berning says. "We as reviewers and coders often don't get the information we need to code as accurately with ICD-9 as we could if we had more precise documentation from clinicians and physicians. I think this problem will be more pronounced with ICD-10's greater specificity," he says.

To access CMS's ICD-10 resources, visit www.cms.hhs.gov/ICD10.