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. Â 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 Â Â Â Â Â Â Â Â Â Fracture of the forearm |
S52.3 Â Â Â Â Â Â Â Fracture of the shaft of the radius |
S52.32Â Â Â Â Â Â Â Â Â Â Â Â Transverse fracture of the shaft of the radius |
S52.321Â Â Â Â Â Â Â Â Â Â Displaced transverse fracture of the shaft of the right radius |
S52.321AÂ Â Â Â Â Â Â Â 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.
Typical Small Practice | Typical Medium Practice | Typical Large Practice | |
---|---|---|---|
Training | $2,700 – $3,000 | $4,800 – $7,900 | $75,100 |
Assessment | $4,300 – $7,000 | $6,535 – $9,600 | $19,320 |
Vendor/Software Upgrades | $0 – $60,000 | $0 – $200,000 | $0 – $2,000,000 |
Process Remediation | $3,312 – $6,701 | $6,211 – $12,990 | $14,874 – #31,821 |
Testing | $15,248 – $28,805 | $47,906 – $93,098 | $428,740 – $880,660 |
Productivity Loss | $8,500 – $20,250 | $72,649 – $166,649 | $725,487 – $1,666,487 |
Payment Disruption | $22,579 – $100,349 | $75,263 – $334,498 | $752,630 – $3,344,976 |
Total Costs |  $56,639 – $226,105 |  $213,364 – $824,735 |  $2,017,151 – $8,018,364 |
Source:Â 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:Â 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:Â Communication and Awareness
- Create a communication plan
- Train your staff what is new of ICD-10. Â 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 &Â Processes
- Verify that your practice are ready for ICD-10