Eli's Rehab Report

Get comfortable with the guidelines and format now, not later.

With a myriad of reimbursement changes staring you in the face, preparing for ICD-10 is probably the last thing you want to think about.

Training for the ICD-9 to ICD-10 transition can easily slide to the bottom of your to-do list since D-day for compliance isn’t until Oct. 1, 2014. But experts recommend you at least get your feet wet now. Take the transition in bite-size pieces starting now, and you’ll flow into the new code set more easily than you expected.

Before you begin: Make sure you’re learning the right code set. You’ll see references to both ICD-10-CM and ICD-10-PCS. For diagnosis coding, you’ll use ICD-10-CM. “ICD-10-PCS is a completely different coding system and designed for hospital inpatient procedures,” points out Kathy DeVault, RHIA, CCS, CCS-P, director of HIM Solutions for AHIMA.

For the purposes of this article, we will be focusing on ICD-10-CM.

Try These Training Strategies

Whatever you do, don’t save your ICD-10 training until the last minute. If you’re unsure of where to start, get an ICD-10 book and begin browsing the codes to get a feel for them and their format, DeVault suggests. You may be surprised at the similarities to ICD-9. “People often say the new code system wasn’t as scary as they expected,” she says.

Good idea: Take the ICD-10 coding guidelines and assign a chapter to each person on your team, DeVault suggests. Have them discuss and compare the differences from ICD-9. “Then you can start to narrow down what’s significant particular to your specialty,” she says.

Send at least one person from your office now for ICD-10 training and have him or her report back the impact of the transition, recommends Joanne Byron, LPN, BSNH, CPC, PCS, CHA, ICDCT-CM, ICDCT-PCS, a Certified ICD-10 Training Instructor with the American Institute of Healthcare Compliance (AIHC), based in Medina, OH. If you’re one of the many rehab practices or facilities that does not use electronic health records or computer-aided coding software, it’s even more important to get a head start on training, she notes.

Understand the Basic Navigation of ICD-10

From the starting gate, you’ll find that the ICD-10-CM guidelines are similar to those of ICD-9-CM. You’ll also find familiarity in the code lookup system. “The condition is referenced in [an] alphabetical index, then confirmed in the tabular,” Byron says.

Key Difference: The main ICD-10 categories are grouped by letter, not number. For example, nervous system diseases make up the G category, diseases of the eye and ear make up the H category, and diseases of the circulatory system make up the I category, etc. These categories, however, break down into more specific alphanumeric codes.

You will also find a larger breakdown of code choices for a disease/condition in ICD-10. This is known as “increased granularity,” Byron explains. In addition, “some of the codes must be completed with 6^th and 7^th characters when referencing the tabular index,” she adds. This is a new concept, as ICD-9 codes only extend up to 5 characters.

Example: If a patient was getting rehab after a fracture, “there is a 7^th character in the injuries chapter [S and T codes] to indicate where the patient is in the spectrum of their care,” DeVault says. “Not all chapters, however, have 7^th characters.”

Glam Up Your Transition Experience With GEMs

Take advantage of General Equivalency Mappings (GEMs), which you can find for free on CMS’ website: www.cms.gov/Medicare/Coding/ICD10/index.html. In a nutshell, GEMs are a system that helps you translate between ICD-9 and ICD-10.

“Using GEMs is a good place to start regarding codes you use most often in ICD-9 and what your coding choices will be in ICD-10,” Byron says. You can also purchase GEMs reference books or mapping software, she adds.

GEMs, however, are not a “simple crosswalk,” CMS explains in its GEM guide. “The GEM files attempt to organize [the] differences in a meaningful way, by linking a code to all valid alternatives in the other code set …”

Don’t be surprised: Because ICD-10 has increased granularity and more character extensions, etc., one ICD-9 code can map over to hundreds of new codes in ICD-10 for the same condition, Byron points out.

Editor’s Note: Watch next month’s Eli’s Rehab Report for more specific examples of ICD-10 coding scenarios.