OASIS Alert

Contrary to popular opinion, the ICD-10 diagnosis code set will not be more difficult to use.

October 2013 might seem like a distant date, but you should start thinking about ICD-10 now. Start by learning the truth about three key areas so that your agency is ready when the implementation deadline rolls around.

Myth #1: Before the 2013 implementation date, there will be several delays so we'll have more time to prepare than we think.

Reality: "The transition date for ICD-10 codes is Oct 1, 2013," stressed CMS's Stewart Streimer during a CMS-sponsored Open Door Forum last year. "That's really the drop-dead date for those of you that have familiarized yourselves with the Final Rule regarding ICD-10 ... but there are a lot of things that must happen before then, and I expect many of the payers may even require ICD-10 codes before then so a sufficient amount of testing can take place," he said.

"There will be no delays on this implementation period, and no grace period," said Pat Brooks, RHIA, with CMS's Hospital and Ambulatory Policy Group, during a CMS Open Door Forum. "A number of you have contacted us about rumors you've heard about postponement of that date or changes to that date, but I can assure you that that is a firm implementation date," she stressed.

No exceptions: No matter where you work (home health agency, hospice, hospital, ambulatory surgical center, physician practice, clinic, etc.), the ICD-10 deadline applies to you. Oct. 1, 2013 will be the date that everyone will begin to use ICD-10. CMS will not accept ICD-9 codes for any dates of service on or after Oct. 1, 2013, but will continue to process claims for services prior to that date for a still unannounced period of time.

Today isn't too soon to start thinking about ICD-10, says Helen Avery, CPC-I, CHC, manager of revenue cycle services at Los Angeles-based Sinaiko Healthcare Consulting. The more familiar you are with the changes, the easier the transition will be. Although you shouldn't start your intensive, in-depth ICD-10 training until six to nine months before implementation, you can prepare in other ways now. "Obtain education and understanding early on so that you will be well equipped," Avery says.

Myth #2: One of the major worries regarding ICD-10 is the increased number of codes making ICD-10 impossible to use.

Reality: That should not be the case, however. While physician documentation will need to be detailed and clear, the diagnosis code set will not be more difficult to use.

Currently, CMS publishes about 14,000 ICD-9 codes, but there will be over 69,000 ICD-10 codes. The additional codes will allow you to provide greater detail in describing diagnoses and procedures, Brooks said. Because ICD-10 codes will often be more detailed and specific than the ICD-9 codes you are used to, you may need to encourage physicians to start providing more detailed documentation..

While ICD-10 will require some improvement in physician documentation, the higher the quality of your documentation now, the easier it will be to avoid unspecified codes, and the faster you will find the accurate ICD-10 code.

"Start by speaking with your physicians now about improving their clinical documentation detail which will be the most important aspect for them and should be started prior to the change," Avery says. "With the increased granularity of ICD-10 code descriptions, payers may use this opportunity to develop increased pay for performance incentives and more specific medical necessity requirements that were never before possible. In light of this, accurate and specific code selections will be necessary but only possible if physicians have improved their ability to paint a clear and more detailed picture of the patient's clinical conditions."

Good news: The rules for assigning ICD-10 codes, as they currently stand, are very similar to the rules for ICD-9. This means that although the codes themselves will change dramatically, you will still follow the same process to determine what conditions to code. "Having been trained in ICD-10-CM, I find determining a diagnosis code to be almost exactly the same as
ICD-9-CM with the exception of a few proposed changes to the ICD-9-CM coding guidelines," Avery explains.

Myth #3: You should leave the preparations to your vendors. Clinicians don't need to be involved.

Reality: Clinicians should be involved in communication with "information system vendors (for EMR, claims processing, etc.) about their plans for the new code set implementation," advises Avery. Changes in IT systems and processes generally require a lot of work, testing, training, and cooperation from staff. "If conversations are started early, budgets are determined, and communication is open, then the entire process will be easier to tackle."

You'll need to work with your software vendors ahead of time to confirm that no issues will exist with claims submissions using ICD-10.