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ICD-10 FOR PHYSICIANS

Summary

We are less than one year away from October 1st, 2015 deadline for the transition from (International Classification for Diseases) ICD-9 to ICD-10. This transition will impact every aspect of claims processing, reimbursement, clinical documentation, payer relations and coding, as well as audit, compliance and risk management.

 

    CMS states the purpose of ICD-9 to ICD-10 is:
  • ICD-9 codes provide limited data about patients’ medical conditions and hospital impatient procedures. ICD-9 is 30 years old, it has outdated and obsolete terms, and is inconsistent with current medical practices. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.
  • ICD-10 codes allow for greater specificity and exactness in describing a patient’s diagnosis and in classifying inpatient procedures. ICD-10 will also accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing. ICD-10 coding will make the billing process more streamlined and efficient, and this will allow for more precise methods of detecting fraud

According to Wolters Kluwer “Physicians will need to incorporate ICD-10 CM diagnosis codes into their daily workflow and understand the specifics behind clinical documentation. They do not need to know how the surgical codes with ICD-10 PCS work, but they should clearly understand that incomplete documentation and inaccurate diagnosis coding will result in a delay in billing.”

 

When ordering services, physicians play a huge role in providing diagnoses to support the ordered services at the highest level of specificity. Incomplete or insufficient diagnostic information at the point of ordering will potentially delay scheduling and registration processes, overall coding processes, increase the volume of queries to the ordering physician, increase overall billing cycle time, overall Accounts Receivable days, and potentially result in medical necessity questions and increased denials.

 

To help with the implementation of ICD-10 Carondelet Health network has taken the following steps:

  1. Created a project that includes Planning, Communications, Testing, and Transition to full compliance.
  2. Formed an ICD-10 Steering Team to manage the ICD-10 implementation.
  3. Formed sub teams to manage specific parts of the ICD-10 implementation.
    • Revenue Cycle and Finance Process
    • Coding and Clinical Documentation Improvement (Case Management, HIM, Chart Reviews)
    • Clinical Operations (Orders and Documentation)
    • Training and Education (Communications)
    • Information Services (Application compliance and testing)
    • Physician Engagement (Feedback to Providers)
  4. Added a site page to the Carondelet Physician Portal for ICD-10 communication, education, and helpful tips.

What can providers do to help?

  • Be proactive in learning about ICD-10
  • Take recommended training courses
  • Learning how to improve documentation to allow coders to correctly code a chart
  • Learning how to provide the additional information needed for Orders
  • Participate in chart review and testing
  • Understand the risks and business impact

 

Field and Structure Differences

 

The field size changes associated with ICD-10 diagnosis and procedure codes will impact storage abilities. Below are the field sizes for Diagnosis and Procedure codes:

 

Another way to view field size changes is by comparing differences in the structured format between ICD-9-CM and ICD-10. The format structure (as illustrated below) contains the "decimal." It should be noted that the HIPAA transaction standards do not allow the transmission of the decimal in the ICD-10-CM code. The decimal is implied in the transmission. There are currently 104,000 codes available now for coding purposes. This number will only increase as there are refinements to the procedures performed and further revisions to diagnosis.

  • ICD-10-CM diagnosis codes - 17K
  • ICD-10-PCS procedure codes - 87K

Find additional news and resources at: www.cms.gov/ICD10


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