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As you are aware, effective October 1, 2015, the ICD-9-CM code set that is used to report medical diagnoses will be replaced with the ICD-10-CM code set. The ICD-10 code set provides more than 68,000 codes, compared to 13,000 in ICD-9, and introduces alphanumeric category classifications for the first time. As such, ICD-10 is much more proficient at describing current conditions yet still possesses the flexibility to expand as needed to accommodate the changing clinical environment.
Under the ICD-9 nomenclature, codes range from three to five digits while diagnosis coding under the ICD-10-CM system employs three to seven digits. The expanded characters of the ICD-10 code set provide greater specificity as they identify additional detail such as disease etiology, anatomic site, severity, episode of care, and laterality. For example, in ICD-9-CM, there is 1 code available for Barrett’s Esophagus which includes the diagnosis of Barrett’s Ulcer. The ICD-10-CM nomenclature expands the code set to 6, adding codes to specify dysplasia and separately categorizing Barrett’s Ulcer. To assign the appropriate Barrett’s ICD-10-CM code, the pathology report should specify:
• Barrett’s esophagus/syndrome/disease
o Without dysplasia
o With dysplasia
• Low grade
• High grade
• Barrett’s ulcer
o Without bleeding
o With bleeding
530.85 Barrett’s esophagus (includes syndrome, ulcer)
K22.70 Barrett’s esophagus without dysplasia (includes syndrome; excludes ulcer)
K22.710 Barrett’s esophagus with low grade dysplasia (includes syndrome; excludes ulcer)
K22.711 Barrett’s esophagus with high grade dysplasia (includes syndrome; excludes ulcer)
K22.719 Barrett’s esophagus with dysplasia, unspecified (includes syndrome; excludes ulcer)
K22.10 Ulcer of esophagus without bleeding
K22.11 Ulcer of esophagus with bleeding
APS Medical Billing’s I.T. Department has completed the programming changes needed to accommodate the increased length and number of codes this change entails. Also, end-to-end testing with Medicare continues, with testing completed successfully with many of the MACs at this time. The same type of testing has begun with many of our clients/facilities. As we anticipate that not all insurance carriers will be ready to accept ICD-10-CM on October 1, it is our intent to house both ICD-9 and ICD-10 codes on each claim with submission of the appropriate code set directed by each carrier’s readiness. The APS system will be prepared to assist as needed in cross-walking between ICD-9 and ICD-10 codes to create the dual code set as planned for each claim.
In preparation for performing diagnosis coding under ICD-10-CM, the APS coding staff has received advanced anatomy and pathophysiology training and completed a 2-day on-site ICD-10-CM training program provided by the American Academy of Professional Coders (AAPC). The Department will continue working with the structure and application of this new version of diagnosis coding to be ready for the cutover on October 1.
For our clients, the APS coding team has begun a project to cross-walk their most frequently used ICD-9-CM diagnosis codes to their corresponding ICD-10-CM codes. Additionally, a summary of the changes will be provided that lists the additional detail that will be needed in the pathology report to properly assign those codes under the ICD-10 format. This information will be tailored to each group so it can readily be used to update systems and incorporate into dictation content as needed.
APS is dedicated to working with our clients to successfully accommodate this impending change. Any questions can be directed to the Account Management staff.
Rancho Mirage, CA