Quick Guideline for IDC-10 Transition Process

About ICD-10

The U.S. Department of Health & Human Services (HHS) has designated ICD-10 as a code set under the Health Insurance Portability & Accountability Act (HIPAA) and it will be required for use by physicians and others in the health care industry beginning October 1, 2015.  It will replace all ICD-9 code sets. Thus, for any healthcare service that occurs on or after October 1, 2015, providers must use ICD-10 codes. This mandate applies to healthcare reimbursement, research, and reporting services. CMS has stated that they will offer no grace period and no additional delays for the transition.

The transition from ICD-9 to ICD-10 will change how you do business and you need to flip the switch by October 1, 2015

Key differences between ICD-9 and ICD-10

Many, many more codes

With a nearly fivefold increase from 14,000 diagnosis codes to over 69,000, and a nearly 19-fold increase from almost 4,000 procedure codes to almost 72,000, the transition from ICD-9 to ICD-10 can seem overwhelming.

Specialties affected differently

While many of the ICD-10 codes are built upon existing ICD-9 codes, some codes are significantly different than ICD-9. Similar diagnoses may have completely different codes. Specialties such as obstetrics, psychiatry, and emergency medicine, along with specialties that deal with musculoskeletal disease and injuries, will encounter disproportionately significant changes.

The differences

ICD-10 codes will be longer to allow for greater specificity and for more flexibility to add new codes. ICD-10 has alphanumeric categories instead of numeric ones. The order of some chapters have changed, some titles have been renamed, and conditions have been grouped differently.

Comparison of Diagnosis Code Sets	Â
ICD-9-CM	ICD-10-CM
3-5 Characters in length	3-7 Characters in length
First character may be alpha or numeric, characters 2-5 are numeric	Character 1 is alpha; Characters 2 and 3 are numeric; characters 4-7 are alpha or numeric
Less specificity	Greater specificity
Laterality not specified	Laterality specified (e.g. left versus right)
Limited space for new codes	Flexibility to add new codes

ICD-10-CM Code Structure

Characters 1 through 3 – Category

Characters 4 through 6 – Etiology, anatomic site, severity, or other clinical detail

Character 7 – Extension

ICD-10-CM Code Detail

S52                  Fracture of the forearm

S52.3               Fracture of the shaft of the radius

S52.32             Transverse fracture of the shaft of the radius

S52.321           Displaced transverse fracture of the shaft of the right radius

S52.321A         Displaced transverse fracture of the shaft of the right radius,initial encounter for closed fracture

Costs of implementing ICD-10

In 2014, the American Medical Association released a report outlining the cost of ICD-10 implementation. For small practices, the report estimated costs could exceed $200,000, while for medium practices the costs could exceed $800,000.

Source: American Medical Association

How an EHR helps you

The biggest worry providers have is that they or their coders will need to learn so many new ICD-10 codes and standards that they will make mistakes, resulting in claim denials. Incorrect coding can mean the difference between full reimbursement and no reimbursement.

Cloud-based EHRs will fare better

Medical professionals who use cloud-based EHRs and billing services should fare better during this transition. Since mappings from ICD-9 to ICD-10 are not one-to-one, electronic tools like EHRs help guide users to the appropriate ICD-10 diagnosis and, in some cases, automate the conversion from one code-system to another. This helps ensure that users are selecting the most specific, billable, ICD-10 code for a particular diagnosis category.

To this end, popular cloud-based EHR systems, such as Practice Fusion, should support your practice through this transition with tools that provide ICD-10 translation support, directly within your EHR workflows.  The company plans to release additional tools, well in advance of the ICD-10 deadline on October 1, 2015, to help you eliminate the need to memorize the differences or to hire a new billing service to handle the work of cross-walking your codes. These tools will walk you through the new ICD-10 coding process, so you can easily learn the codes as you work while avoiding disruption to your workflow.

Implementation Timeline & Phases

Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and budget. Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans.

Step 1: Planning

• Obtain ICD-10 CD-ROM (Contact us now to get a copy of IDC-10 CD-ROM)
• Select clearinghouse that will play in our transition.
• Establish project management structure
• Establish governance
• Plan to communicate with external partners
• Establish risk management

Step 2: Communication and Awareness

• Create a communication plan
• Train your staff what is new of ICD-10.  Online, self-paced courses on ICD-10 is available here
• Identify the common codes that apply to your clinic

Step 3: Update your Paperwork, Processes

• Update hard-copy and electronic forms

Step 4: Coordinate with your Vendors and Health Carrier

• Notify your partners that ICD-10 is ready at your practice

Step 5: Testing Your Systems & Processes

• Verify that your practice are ready for ICD-10