Preparing for ICD-10

Right around the corner the new code set for diagnosis codes arrives.  After delays and debates, October 1, 2015 will be the day we all have to begin using ICD-10 codes.  Of course, not all third party payors will be accepting the new codes.  “Non-covered” entities, like workers compensation are not required to comply with ICD-10.  Our job becomes difficult once again, managing who to send ICD-10 codes to and who to continue sending ICD-9 codes to.  The provider’s job is to capture the most complete description they can, both in the chart and what is sent to the back office for billing.  One important point to make, this does not impact procedural coding only diagnosis coding.

If you have not already prepared, now is the time to get with your facilities and coordinate how to document medical records.  ICD-9 and ICD-10 are not the same. To help you, many of the major payors as well as CMS have training and educational guides easily found on the web.  In addition to the link below, another would be https://www.cms.gov/Medicare/Coding/ICD10/.  In the recent article from Brenda Edwards, CPC, CPB, CPMA, CPC-1, CEMC, CRC, KaMMCO, we found the following.

ICD-10-CM “Rules of the Road”
Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC

Coding & Compliance Specialist, KaMMCO

A major change in the sustainable growth rate (SGR) payment formula was implemented in April 2015. A delay for ICD-10-CM implementation was not included in the bill. There have been further attempts by Congress to delay ICD-10-CM or allow “hardship exemptions” to let unprepared providers delay ICD-10-CM, at least temporarily. The Centers for Medicare and Medicaid Services (CMS) has made assurances that the October 1 deadline is firm. CMS, as well as payers and providers, were given an extension last year to prepare and work out problems through testing.

Now is the time to prepare for the new code set by reviewing today’s medical record. Will current documentation support the additional requirements of ICD-10-CM? There are some things to keep in mind when comparing the new code set with ICD-9-CM. The following “Rules of the Road” should be kept in mind when comparing the new code set with ICD-9-CM:

1. Rules in ICD-9-CM and ICD-10-CM are not necessarily the same: Become familiar with the Official Coding Guidelines. The guidelines can be downloaded at http://www.cdc.gov/nchs/icd/icd10cm.htm.
2. Coding from the Alphabetic Index may not produce a complete code: There are incomplete codes identified with a “-” or the initial guidance may be directed to a less specific code.
3. Coding from the Neoplasm Table may not produce a complete code: Again, as with the Alphabetic Index, the Neoplasm Table may not list the complete code since there may be variables to be taken into consideration once the Tabular Index is consulted.
4. Coding in ICD-10-CM is a three-step process to locate a code:
   1. Begin in the Alphabetic Index to locate the condition and any other specific information to drill down to a beginning point in the Tabular Index.
   2. Consult the Tabular Index and don’t stop at the code choice supplied in the Alphabetic Index. It is important to scan the codes both before and after the possible code choice to ensure the most accurate level of detail has been obtained.
   3. The third step in the process is to review the Official Coding Guidelines for any further guidance.
5. READ THE RED! Many companies that publish a branded ICD-10-CM manual have added information to aid in finding the most specific code available. The AAPC ICD-10-CM code set contains red narrative in the Tabular Index that is imperative to consult. This information will include sequencing rules (code first), notation of coding additional conditions (code also), when present, and other valuable information.
6. Watch for signs! There are many important indicators in the Tabular Index identifying the length of the code, when it is appropriate to code specific conditions together, and other tools.
7. Memorizing may be futile. Many coders and providers may be walking ICD-9-CM manuals because we have used this code set for so many years. This will be difficult in ICD-10-CM because of the addition of laterality, temporal conditions, and other modifying factors for each code.
8. Laterality isn’t always the same. Typically the character “1” will represent the right side and “2” will indicate the left side. Codes for eyelids will throw this way of thinking into a tailspin since there are 2 upper and 2 lower lids (right and left) to account for.
9. How many codes to assign? The answer is as many as needed that affect treatment of the condition(s) at hand. Since ICD-9-CM and ICD-10-CM are different code sets, don’t expect to see the same number of codes reported since combination codes or manifestations could increase or decrease the number of codes required.
10. What if there is a disagreement in code choice? “Rule out,” “Suspect,” and other less than definitive terms cannot be coded, nor can an assumption be made. The bottom line is if the documentation is unclear, the best bet is to query the provider for additional information. Ongoing, two-way communication between providers and support staff will be imperative as the transition to ICD-10-CM takes place.

The ICD-10-CM “Rules of the Road” may take time to become accustomed to; the same could have been said thirty-some years ago when the move was made to ICD-9-CM. The increased specificity found in documentation will also be an important piece of information in future payments that could be based on quality of care.

For additional coding blog articles from this author, visit http://news.aapc.com and search Brenda Edwards.†

Reprinted with permission from KaMMCO.

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Editor:  Philip Blann (pblann@anesthesiabilling.com).