Outpatient Facility Coding Alert

Bear in mind the new timeline and be educated.

With the healthcare industry on edge and ready to jump into the transition to ICD-10, now is “the time” to start the education process. Ensure your training is on target – and that you’re separating myth from fact – so you aren’t caught up in any surprises when ICD-10 becomes effective.

Choose Your ICD-10 Coding Manual

Myth #1: You don’t need to purchase an ICD-10 coding manual.

“The truth is that coders planning to learn the ICD-10 code set must purchase an ICD-10 coding manual in order to properly complete training,” says Brandi Whitemyer, RN, COS-C, HCS-D, HCS-O, AHIMA Approved ICD-10 Trainer/Ambassador.

“Don’t let someone fool you into thinking that the GEMs (General Equivalence Mappings) noted in the current ICD-9 Manual are an acceptable method for learning,” Whitemyer says.

CMS states, “The GEMs are not a substitute for learning how to use ICD-10-CM and ICD-10-PCS. Providers’ coding staff will assign codes describing the patients’ encounters from the ICD-10-CM and ICD-10-PCS code books…” (CMS ICD-9-CM Notice, General Equivalence Mappings, April 2010, pg1).

“Not only is trying to use the GEMs for learning likely to mislead your ICD-10 coding experience, but without the use of a current ICD-10-CM manual, you will not have access to coding guidance,” Whitemyer cautions.

Why? Just as is true in your current ICD-9 coding manual, the ICD-10 manual includes guidance such as when to use an additional code, and Excludes 1 and 2 notes, Whitemyer says. “These features are essential for the training process and any attempt to learn the ICD-10 code set without access to this information is incomplete.”

“The manual may be in hard copy or electronic, but either way, an ICD-10-CM manual is an important reference tool for coders,” adds Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. 

Pay Attention to Site of Service

Myth #2: Everyone will use the same codes in ICD-10, so you can code the same regardless of the provider setting.

Wrong again, says Whitemyer. The implementation and use of the ICD-10-CM code set is tied to HIPAA regulations, so all providers will be required to make the transition and use the same code set. But coders will continue to utilize provider-specific guidance in assigning diagnoses codes, Whitemyer says.

Steer Clear of Repeated Diagnoses

Myth #3: In ICD-10-CM, you can use the same code twice.

Absolutely not, Whitemyer says. Listing the exact same code twice in ICD-10-CM is no different than it is now — a mistake. It would be redundant and violate coding guidelines.

Yet some coders have leapt to this conclusion when reviewing the ICD-10 code set. “Coders, this is where you must be cautiously diligent to involve yourself in ICD-10 education and ensure your complete understanding,” Whitemyer says.

Have a Transition Plan

As you move from a code set of only 13,000 ICD-9-CM codes compared to ICD-10-CM’s 68,000, every facility needs to have a plan for a smooth and structured transition to the ICD-10 system.

“A good transition plan starts now,” adds Moore. “The first steps are to select an internal champion and/or transition committee to manage the process and to set a schedule for getting everything done between now and October 1, 2015.”

Gold standard: Be sure that an AHIMA Approved ICD-10-CM Trainer provides any ICD-10 training, and verify any information that sounds suspect, Whitemyer advises. “Coders need to keep in mind that just one course in ICD-10 won’t do, and that training and practice will be necessary to become comfortable working in the new code set.”