ICD-10 Update

CMS recently confirmed that the implementation date for ICD-10-CM is October 1, 2014, for all Health Insurance Portability and Accountability Act (HIPAA)-covered entities.  As with ICD-9-CM, ICD-10-CM is based on the International Classification of Diseases, published by the World Health Organization, which designates unique codes to identify health conditions and reasons for medical services.  It offers more than 68,000 diagnostic codes, compared to 13,000 in ICD-9-CM, and introduces alphanumeric category classifications for the first time.  As such, ICD-10 is much more proficient at describing current conditions and healthcare practices and possesses the flexibility to expand to accommodate advancements in clinical medicine.

What does the change represent to providers?  As providers are ultimately the source of the codes submitted to payers for claims processing, it is essential that processes, systems and reporting are upgraded to accommodate the new code structure.   Under ICD-9, codes range from three to five digits while diagnosis coding under the ICD-10 system uses three to seven digits.  The expanded number of characters of the ICD-10 diagnosis codes provides greater specificity to identify disease etiology, anatomic site, and severity.  Because these additional digits allow for more information to be conveyed in a code, providers will need to enhance their documentation to include the additional detail needed for proper code assignment.  For example, most ICD-10 codes contain digits not required in the ICD-9 code set such as:

• exact location   
• laterality
• comorbidity and comortality
• cause of injury/illness
• severity
• exact digit/limb
• episode of care
• location of patient at time of injury

Payers are also operating under the same deadline as providers for this implementation and must be able to accept and process ICD-10 codes for services rendered on and after October 1, 2014.  Business processes, claims edits, quality measures, medical review policies, and payment calculations are a few of the contributing processes and systems that require revamping to accommodate the new codes, adjudicate claims, and communicate payment results.

Preparation for ICD-10 at APS Medical Billing began in 2010, with the majority of the basic programming changes already completed that will allow us to electronically receive, process and transmit the increased number and length of ICD-10 codes under this coding structure.  Closer to implementation, end-to-end testing with our clients’ facilities will be scheduled to ensure the successful transfer of data for processing and billing.  Testing with payers will also be coordinated to ensure they can receive and process our claims correctly and continue providing explanation of payment.  Additionally, in keeping with industry recommendations to dedicate a year to coding training, the APS coding team will begin in-depth training on ICD-10 in the next few months to complement the basic nomenclature studied thus far. 

APS will continue to provide updates to our clients on industry communications and updates related to the implementation of this next generation of diagnosis coding as we move through the preparation period.  At this time if you have any preliminary questions or concerns, please feel free to contact Karen Harmon, Director of Coding and Compliance, at 800-288-8325 x. 1407 or by email at kmharmon@apsmedbill.com.