ICD 10 Coding Alert

Start learning your way around the ICD-10 manual.

What’s next? Ever since the surprise ICD-10 delay brought about during an early April effort to stave off a looming physician pay cut, coders across the healthcare industry have been wondering how the transition will play out. Unfortunately, months later the details still aren’t settled.

While the Inpatient Prospective Payment proposed rule alluded to an Oct. 1, 2015 start date for the new code set, that doesn’t mean the new date will be carved in stone once the IPP final rule is settled. “Actually, the handling of ICD-10 is a separate issue,” said Chris Ritter from the Centers for Medicare & Medicaid Services during a May 13 Open Door Forum for docs. 

“The proposed IPPS rule does simply indicate that the recent legislation does delay ICD-10, and the secretary will be issuing a rule separately, but there will be a separate final rule for ICD-10. You can keep your eyes out for that,” Ritter said.

“On April 1, 2014, the Protecting Access to Medicare Act of 2014 was enacted, and it says that the secretary may not adopt ICD-10 prior to Oct. 1, 2015,” Ritter said. 

“Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015. The rule will also require HIPAA-covered entities to continue to use ICD-9- CM through Sept. 30, 2015.”

The Freeze is On

Along with plans for an interim final rule setting the new ICD-10 compliance date, CMS also announced that the ICD-9 code freeze will remain in effect through October 1, 2015.

The partial freeze will be implemented as follows, CMS said: 

• October 1, 2014 — limited code updates to both the ICD-9 and ICD-10 code sets to capture new technologies and diseases. 
• On October 1, 2015 — limited code updates to ICD-10 code sets to capture new technologies and diagnoses. No updates to ICD-9. 
• October 1, 2016 — regular updates to ICD-10 begin.

“What we do know is that, despite ongoing code freezes, changes have been made in the ICD-10-CM code set including changes to instructions in the tabular list, corrections to the alphabetical index and tweaks to the guidelines themselves. So don’t kid yourself that nothing is new,” adds Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right. “‘Code freeze’ apparently only means ‘no new codes,’ since any codes for new diseases will likely not impact home health.”

Get Your Feet Wet

If you haven’t already begun to dig into the ICD-10 code set, the delay gives you more time to prepare.

If you’re an experienced coder, you can probably find your way around your ICD-9 coding manual with your eyes closed. But ICD-10 reorganizes many codes so you’ll need to start learning a new route.

Each ICD-10 code begins with a letter and these letters indicate the tabular chapter from which the code comes. This humorous memory tool from Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O, consultant and principal of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas will help you to become acquainted with ICD-10’s organization. 

• A & B — Infectious and Parasitic Diseases = Anti-Biotics
• C — Neoplasms = Cancer
• D — Neoplasms and Blood and Blood-Forming Organs = Darn! More Neoplasms and Disorders of the Blood
• E — Endocrine, Nutritional, and Metabolic
• F — Mental and Behavior Disorders = Freud
• G — Nervous System = Ganglion
• H — Eye and Adnexa, Ear and Mastoid Process = Hearing
• I — Circulatory System = Ischemia
• J — Respiratory System = Junk in your lungs
• K — Digestive System = Special K (fiber is good for your digestive system)
• L — Skin and Subcutaneous = Lovely skin
• M — Musculoskeletal 
• N — Genitourinary = Naughty parts
• — Pregnancy, Childbirth and Puerperium = Obstetrics
• P — Perinatal Period
• Q — Congenital Malformations, Deformations and Chromosomal Abnormalities = Quirky conditions
• R — Symptoms, Signs and Abnormal Clinical and Laboratory Findings = Should be coded Rarely
• S & T — Injury, Poisoning and Certain Other Consequences of External Causes = Strychnine and Trauma
• V, W, X, Y — External Causes of Morbidity= Victims of Violence and Accident
• Z — Factors Influencing Health Status and Contact with Health Services = Codes of last resort. Appropriately, the last letter of the alphabet.