ICD 10 Coding Alert

Heed these key advantages to early ICD-10 mastery.

If you've been avoiding the prospect of diving into ICD-10-CM, it's time to face the music. The good news is it's probably a lot less scary than you think. Taking small steps now to accustom yourself and your physicians to ICD-10-CM means that you'll be ahead of the game before October 1, 2013 hits. Remember, you won't have any grace period.

Use these six questions and answers -- and the examples that follow -- provided by Suzanne Leder, BA, M. Phil., CPC, COBGC, Certified AHIMA ICD-10 Trainer, executive editor with The Coding Institute, to set your training in motion:

1. Why should I learn ICD-10 now?

The shift from ICD-9 to ICD-10 will not be simple. Productivity in your practice will be an issue prior to and after implementation. In other words, it will take longer for you to code your claims in ICD-10 until you're finished with the learning curve. Imagine too that you're going to have to ask your physicians to clarify their documentation so you can get to that ultra specific code.

You'll probably see an increase in billing inquiries from payers. You'll also probably encounter an increased number of adjustments and pending or suspended claims. That's why getting a jump start is such a wise decision. The more you can streamline this, the more you can assist your practice's bottom line.

Heads up, CPCs: Did you know that Certified Professional Coders (CPCs) will have tore-take the diagnosis portion of the exam? But stop and look at it this way: If you begin learning ICD-10 now, then you'll be in more demand in the very near future. Being on the cutting edge means that you're more marketable in the medical coding healthcare field, which definitely seems like a good idea in the current economy.

According to the Bureau of Labor Statistics, healthcare is the largest US industry. Healthcare will generate three million new jobs through 2016 -- more than any other industry. If you're ICD-10 trained, you'll have the advantage. So this seems more like an opportunity rather than a chore.

2. Who else is using ICD-10?

Obviously, adoption here in the US has been slow, but other countries around the world have already been using it.

Countries that have adopted ICD-10:

• Australia (since 1998)
• Canada (since 2000)
• France (since 2005)
• Germany
• Korea
• Sweden
• Thailand.

3. Why is ICD-9-CM Changing?

"Frankly, ICD-9-CM is running out of room. Let's think about what 'running out of room' means," Leder says. The first digit of an ICD-9-CM code is a number, which limits code options. For instance, the code for osteoporosis is 733.01 right now. The "7" is the first digit. In ICD-9-CM, we can only go from 0-9. In ICD-10-CM, you'll report M81.0 for osteoporosis. The "M" is the first digit, meaning that we can go from A-Z before even tapping into numbers.

Also new for ICD-10-CM is the expansion of 5 digits to 7 digits. Look at this seven digit example. 'Abrasion of unspecified hand; initial encounter' will be S60.519A. 'Abrasion of unspecified hand; subsequent encounter' will be S60.519D.

4. What's so great about ICD-10-CM?

Good news: You will encounter other advantages to ICD-10-CM, besides it having more room for growth. Here are a few to consider:

• More information relevant to ambulatory and managed care
• Combo codes for diagnosis/symptoms (example: R65.21, Severe sepsis with shock)
• Expanded injury codes
• Trimester info
• Expanded alcohol/substance abuse codes
• Expanded post-op complication codes.

We're going to have more info relevant to ambulatory and managed care.

We're going to have combo codes for diagnoses/symptoms -- and here's the benefit to you: It'll reduce the number of diagnosis codes you have to report to describe a specific condition.

For instance: Right now, if a patient has severe sepsis with shock, you would report 995.92 (Severe sepsis) and 785.52 (Septic shock). For ICD-10, you'll have a consolidated code:R65.21 (Severe sepsis with shock).

We're going to have expanded injury codes which will allow us to describe the injuries as well as the external causes of injuries.

Also, here's something great for providers seeing ob patients, Leder says: "We'll have new codes that will need to specify trimester."

In addition, we'll have expanded alcohol and substance abuse options as well as more options for post-operative complications.

5. What's the difference between ICD-9-CM and ICD-10-CM besides 'more room' and greater specificity?

First off, your ICD-10 manual will be different from your ICD- 9 one. With ICD-10, you'll have three volumes rather than two: Volume I: Tabular Listing, Volume II: Instructional Manual, and Volume III: Alphabetic Index.

Also different under ICD-10, you'll search under alphanumeric categories rather than numeric categories. ICD-10 has twice as many categories as ICD-9.

You'll have to reacquaint yourself with the chapters, as they have been rearranged. Some of the titles will change. The conditions have been regrouped. Also, you'll have to get to know some minor changes to the coding rules for mortality. For bilateral sites, you'll find a final character in the codes in which ICD-10 specifies if one side or both sides. For instance, right side is always "1." Left side is always character "2." Bilateral is always "3." For instance, if your physician sees a patient for a follow-up visit where he examines an abscess of a bursa on the right wrist. You would report M71.031. Notice how the last digit is "1." If this was for the left wrist, you would've reported M71.032.

6. What do I not have to re-learn for ICD-10-CM?

Before you get too overwhelmed, you should know that some things will remain similar. In other words, you won't have to re-learn these coding conventions:

• Indented format
• Rubric system
• Index
• Tabular convention
• Includes notes
• Inclusion terms
• Exceptions
• Neoplasm table.

Editor's Note: See upcoming issues of ICD-10 Coding Alert for more practical ICD-10 training strategies, including advice on implementing an ICD-10 action plan and other topics. And watch for news about The Coding Institute's special e-learning ICD-10 curriculum, a complete online course with associated CEUs. If you have specific training requests or questions, please email Suzanne Leder at suzannel@codinginstitute.com.