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ICD-10 FAQ
Below are a list of frequently asked questions about ICD-10, its implementation, and how it might affect you.
What is ICD-10?
When will ICD-10-CM and ICD-10-PCS be implemented?
Why is the United States moving to ICD-10-CM?
How is ICD-10-CM different from our current system?
What can I do to prepare for ICD-10-CM?
How much is this going to cost?
Am I going to have to sit for my CPC (-H, -P) again to keep my AAPC credential once ICD-10-CM is implemented?
What about ICD-10-PCS?
What is ICD-10?
ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is in almost every country in the world, except the United States.
When we hear “ICD-10” in the United States, it usually refers to the U.S. clinical modification of ICD-10: ICD-10-CM. This code set has not been adopted but is under consideration to replace ICD-9-CM, our current U.S. diagnostic code set.
Another designation, ICD-10-PCS, for “procedural coding system,” is also under consideration for adoption in the United States. ICD-10-PCS would replace Volume 3 of ICD-9-CM as the inpatient procedural coding system. Current plans would see CPT remain the coding system for physician services.
More information on WHO’s ICD-10 code set can be found at http://www.who.int/classifications/icd/en/.
When will ICD-10-CM and ICD-10-PCS be implemented?
A date has not been set for implementation of these code sets, however, it is the recommendation of the National Committee for Vital Health Statistics that both code sets be adopted concurrently. Under normal circumstances, it takes a minimum of 28 months for implementation of a federal mandate of this magnitude. Here are the steps needed to effect this conversion:
- Publication of the Proposed Rule in the Federal Register with a 60-day public comment period;
- Analysis of the public comments and publication of the Final Rule in the Federal Register with an effective date of 60 days after Final Rule; and
3. Distribution of standards, coordination of preparation and distribution of implementation guidelines and crosswalks. Implementation is 24 months from effective date, excluding small health plans (fewer than 50 participants) which have 36 months to comply.
It is assumed that the government will follow this normal protocol for adoption of these code sets. Among the norms:
- The government’s fiscal year begins October 1, and the adoption would likely coincide with the fiscal year, similar to normal ICD-9-CM update schedules
- A required 28-month lead-time and an October implementation date would put the earliest possible implementation date at October 2010, for the 2011 ICD codeset. For this date to stand, a proposed rule would need to be published in the Federal Register by June, 2008.
Why is the United States moving to ICD-10-CM?
ICD-9-CM has several problems. Foremost, it is out of room. Because the classification is organized scientifically, each three-digit category can have only 10 subcategories. Most numbers in most categories have been assigned diagnoses. Medical science keeps making new discoveries, and there are no numbers to assign these diagnoses.
Computer science, combined with new, more detailed codes of ICD-10-CM, will allow for better analysis of disease patterns and treatment outcomes that can advance medical care provided. These same details will streamline claims submissions, since these details will make the initial claim much easier for payers to understand.
How is ICD-10-CM different from our current system?
In many ways, ICD-10-CM is quite similar to ICD-9-CM. The guidelines, conventions, and rules are very similar. The organization of the codes is very similar. Anyone who is qualified to code ICD-9-CM should be able to easily make the transition to coding ICD-10-CM.
Many improvements have been made to coding in ICD-10-CM. For example, a single code can be found to report a disease and its current manifestation (i.e., type II diabetes with diabetic retinopathy). In fracture care, the code differentiates an encounter for an initial fracture; follow-up of fracture healing normally; follow-up with fracture in malunion or nonunion; or follow-up for late effects of a fracture. Likewise, the trimester is designated in obstetrical codes.
While much has been said about the huge increase in the number of codes under ICD-10-CM, some of this growth is due to laterality. While an ICD-9-CM code may identify a condition of, for example, the ovary, the parallel ICD-10-CM code identifies four codes: unspecified ovary, right ovary, left ovary, or bilateral condition of the ovaries.
The big differences between the two systems are differences that will affect information technology and software at your practice. Here’s a chart showing the differences:
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Issue
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ICD-9-CM
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ICD-10-CM
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Volume of codes
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approximately 13,600
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approximately 120,000
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Composition of codes
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Mostly numeric, with E and V codes alphanumeric. Valid codes of three, four, or five digits.
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All codes are alphanumeric, beginning with a letter, and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digits.
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Duplication of code sets
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Currently, only ICD-9-CM codes are required . No mapping is necessary.
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For a period of up to two years, systems will need to access both ICD-9-CM codes and ICD-10-CM codes as the country transitions from ICD-9-CM to ICD-10-CM. Mapping will be necessary so that equivalent codes can be found for issues of disease tracking, medical necessity edits, and outcomes studies.
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What can I do to prepare for ICD-10-CM?
Watch your Coding Edge magazine and EdgeBlast to keep up with the latest news. Become familiar with the codes themselves, and determine what issues are going to be problematic for you.
Under ICD-9-CM, physician documentation is said by most coders to be the number one difficulty for code selection. Underdocumentation is an even larger problem with ICD-10-CM, so physician education will be very important.
How much is this going to cost?
The most important thing to remember about the cost of ICD-10-CM is that investments you are making today will impact that cost when implementation occurs tomorrow. So keep ICD-10-CM in your mind as you are making decisions on EMR or other software systems. As your vendors if their products are ICD-10-CM ready, and what costs you will be expected to shoulder when implementation occurs. Consider whether print media will continue to be a viable look-up methodology when the code set swells nearly tenfold. For specifics on the cost to the government, providers, hospitals and payers, review two cost studies commissioned in recent years. These studies can be found at http://www.rand.org/pubs/technical_reports/TR132/index.html and http://www.renolan.com/healthcare/icd10study_1003.pdf
Am I going to have to sit for my CPC (-H, -P) again to keep my AAPC credential once ICD-10-CM is implemented?
AAPC will want to ensure that every credentialed member is proficient in ICD-10-CM coding within a reasonable timeframe around implementation, but no new certification exam will be required. AAPC is currently evaluating methods to qualify credentialed coders as competent in ICD-10-CM, and members can expect that some formal process will be put in place that will require CEUs or some online training in order to maintain their credentials under ICD-10-CM. This qualifying process will be widely publicized and the timeframe for completion of the process will be broad enough to allow all credentialed members ample time for completion.
AAPC will also revise its exam to accommodate ICD-10-CM, and begin using the new exam at the time of code implementation. This is different from the current exam cycle in which the ICD-9-CM codes are updated in January, rather than October when they become effective.
What about ICD-10-PCS?
ICD-10-PCS is a code set under consideration to replace Volume 3 of ICD-9-CM for inpatient procedure reporting. It would be used by hospitals and by payers. ICD-10-PCS is significantly different from Volume 3 and from CPT codes, and will require significant training for users. The system was designed by 3M Health Information Management for the Centers for Medicare and Medicaid.
ICD-10-PCS will not affect coding of physician services in their offices. However, physicians should be aware that documentation requirements under ICD-CM-PCS are quite different, so their impatient medical record documentation will be affected by this change.
ICD-10-PCS has nearly 200,000 seven-digit alpha-numeric codes. Codes are selected from complex grids, based on the type of procedure performed, approach, body part, and other characteristics. The code system does not use medical terminology based on Latin or eponyms. More information on ICd-10-PCS, including an informative PowerPoint presentation that describes the coding system, can be found at
http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/08_ICD10.asp