Pathology/Lab Coding Alert

Start now to get your lab ready for the new diagnosis code set.

If the ICD-10 implementation date (Oct. 1, 2013) sounds far away to you -- think again. In terms of the prep work you should be doing to get ready, the deadline is right around the corner.

That's the word from CMS reps during a recent Open Door Forum explaining ICD-10. Read on to see what the experts have to say to dispel ICD-10 misinformation that could leave you unprepared.

Myth 1: You'll Have an ICD-10 Grace Period

CMS says the deadline for using ICD-10 is firm -- whether you work in a hospital lab, independent lab, or physician office lab, the 2013 deadline applies to you.

"I must stress quite strongly that Oct. 1, 2013 will be the date that everyone will begin to use ICD-10. There will be no grace period," said Pat Brooks, RHIA, senior technical advisor with CMS, during the call. "In other words, we will not be slipping the date beyond Oct. 1, 2013 for ICD-10 codes, and this will be a compulsory implementation of this system."

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 period of time," Brooks added.

Myth 2: You'll Only Find ICD-10 Electronically

"One myth is that there won't be any hard-copy ICD-10 code books," said Sue Bowman, RHIA, CCS, director of coding policy and compliance with the American Health Information

Management Association (AHIMA), "but that's not true." While you can find the files electronically (www.cms.gov/ICD10/12_2010_ICD_10_CM.asp#TopOfPage), some publishers have already printed ICD-10-CM code books. The available ICD-10 books "are of a normal, manageable size," Bowman says.

Myth 3: You'll Need to Overhaul Your Documentation Practices

Because ICD-10 is more detailed, the buzz on the street is that insurers will require unnecessarily detailed medical record documentation.

That's not true, according to Bowman, who noted that "much of the detail contained in ICD-10-CM is already in the medical record documentation -- it's just not being utilized because it's not needed for ICD-9 coding."

For instance: If the pathologist diagnosed a benign neoplasm of the cecum, the correct ICD-9 code would be 211.3 (Benign neoplasm of other parts of digestive system, colon). The examples under 211.3 include cecum, but also include other colon sites such as large intestine not otherwise specified. For ICD-10, you'll report D12.0 (Benign neoplasm of cecum). ICD- 10 provides separate codes for other or unspecified colon sites, such as D12.6 (Benign neoplasm of colon, unspecified).

Myth 4: ICD-10 Won't Be User-Friendly

One of the bigger myths regarding ICD-10 is that the increased number of codes will make ICD-10 impossible to use. Not so, Bowman said.

"Just as the size of a dictionary doesn't make the dictionary more difficult to use, a higher number of codes doesn't necessarily increase the complexity of the coding," Bowman said. In fact, she noted, greater specificity and clinical accuracy should actually make ICD-10 easier to use.

Myth 5: Preparation Can Wait

You don't need to start your intensive, in-depth ICD-10 training until six to nine months before implementation, but you should prepare in other ways now, Bowman said.

Improve documentation: Although ICD-10 won't necessarily require better documentation than ICD-9, there's always room for improvement. So start identifying medical record documentation improvement opportunities now, Bowman advised. The higher quality your documentation is, the easier it will be to avoid using unspecified codes and the faster you'll find the accurate ICD-10 code once you change code sets.

Learn the basics: You can also start learning the basic structure, organization, and unique features of ICD-10, and refresh your knowledge of biomedical concepts so you won't be tripped up by more enhanced code definitions and descriptions. You can start by accessing the ICD-10-CM Quick Reference Information sheet, available at www.cms. hhs.gov/icd10, and then click "CMS sponsored calls" on the left, followed by the "2010 ICD-10 Conference Calls" download.

Look for new form: Longer ICD-10 codes won't mesh with current CMS form 1500. "Beginning on or after Jan. 1, 2011, CMS (and I'm sure other payers) will be prepared to accept claims using the 5010 format, which  will accept more characters for your codes," Brooks said. She noted that the 5010 will, at that point, be "the new universal claim format."