Get Your ICD-10 Questions Answered
Published in Coding Edge – August 2010
Put yourself in a good position to assist your organizations.
By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, COBGC, CPCD, CCS-P
The ICD-10 Roadmap has led us to the countdown to implementation. If your practice, health plan or organization has not started thinking about the ICD-10 transition, the time to start is NOW! I cannot stress this enough—if you do not begin the process now, your organization could be at risk financially.
Widespread confusion about ICD-10 exists throughout the industry. Getting answers to your hard-pressed questions will ensure a smoother transition in 2013. The following are the most common ICD-10 questions we have received at AAPC:
Q1: Is the Oct. 1, 2013 compliance date for ICD-10 implementation flexible? Will the go-live date be delayed?
A: All covered entities of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 MUST implement the new code sets on Oct. 1, 2013.
Q2: Is the ICD-10-CM effective date based on service date or submission date for outpatient services?
A: For all outpatient services, including ambulatory and physician services, the date of service is the effective date. For inpatient hospital facility reporting, if the patient is admitted prior to Oct. 1, 2013 and discharged after Oct. 1, 2013, the discharge date is the key determining factor whether an ICD-9-CM code or ICD-10-CM/PCS code is reported.
Q3: Will the U.S. Department of Health and Human Services (HHS) grant an extension beyond the Oct. 1, 2013 date? It is typical of HHS and the Centers for Medicare & Medicaid Services (CMS) to delay?
A: HHS has no plans to extend the compliance deadline date ICD-10-CM/PCS implementation. All covered entities should plan to complete the steps required to implement ICD-10-CM/PCS, and get ready to go live on Oct. 1, 2013.
Q4: Non-covered entities are not covered under HIPAA. This includes workers’ compensation and auto insurance companies that use ICD-9-CM and use older versions of ICD-9-CM. Are they mandated to move to ICD-10-CM/PCS?
A: No. However, because ICD-9-CM will no longer be maintained after ICD-10-CM/PCS is implemented, it is in the non-covered entities’ best interest to use the new coding system. The increased detail in ICD-10-CM/PCS is of signiﬁcant value to non-covered entities. Hopefully, many workers’ compensation and auto insurance companies will implement ICD-10 along with the covered entities.
Q5: Modifier 50 Bilateral procedure is not applicable to diagnosis coding but applicable to CPT®. Would the laterality in ICD-10-CM, help support the use of modifier 50 on a CPT® code?
A: Laterality in ICD-10-CM is reportable for many ICD-10-CM codes. Many ICD-10-CM codes identify the left and right side of the body and bilateral. If a procedure or service is reported bilaterally, the specificity in ICD-10-CM would help support use of modifier 50. The American Medical Association (AMA) has made no assumptions that modifier 50 will be eliminated from CPT® nor has any discussion taken place so far to eliminate modifier 50 from CPT®. Keep in mind that not all ICD-10-CM codes support laterality.
Q6: Do you think there will be a transition time when we will be submitting both ICD-9-CM and ICD-10-CM codes at the same time for different payers/carriers?
A: No. There has been no indication that we will use both ICD-9-CM codes and ICD-10-CM codes simultaneously. Beginning Oct. 1, 2013, we must begin using ICD-10-CM codes. This includes hospitals, physicians, ambulatory services, health plans and all other health care providers. We will however need to utilize both ICD-9-CM and ICD-10-CM/PCS until all outstanding, pended, or appealed claims for services rendered prior to Oct. 1, 2013 are resolved.
Q7: Will ICD-10-PCS be required to report diagnoses for physician (professional) and outpatient services?
A: ICD-10-PCS will not affect coding of physician or outpatient services provided in the outpatient setting; however, physicians should be aware documentation requirements under ICD-CM-PCS are quite different. Their inpatient medical record documentation will be affected by this change.
Q8: Will unnecessary detailed medical record documentation be required when ICD-10-CM/PCS is implemented?
A: As with ICD-9-CM, ICD-10-CM/PCS codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for use when documentation doesn’t support a higher level of specificity. Keep in mind, however, you need to use caution when selecting an unspecified ICD-10-CM code as the purpose of moving to ICD-10-CM/PCS is the detail and specificity, which may reduce requests by payers/carriers for documentation and provide a greater support of medical necessity.
Q9: Can ICD-10-CM/PCS implementation can wait until after electronic health records (EHRs) and other health care initiatives have been established?
A: Implementation of ICD-10-CM/PCS cannot wait for the implementation of other health care initiatives. As management of health information becomes increasingly electronic, the cost of implementing a new coding system will be greater due to required systems and applications upgrades. If you are planning to implement an EHR it might be a good time to do so during the ICD-10-CM/PCS implementation process.
Q10: If various countries have their own version of ICD-10, how can the information really be transferable for one country to another?
A: The World Health Organization (WHO) has standards that a country must adhere to if they want to create their own version and those rigorous standards allow for interoperability between the various versions. The ‘base’ set of information across all of ICD-10 is comparable between each clinical modification in use.
Q11: What is the estimate timeframe for the ICD-9 to ICD-10 conversion for an EHR system?
A: Vendors of EHR systems have the same compliance requirements as providers and health plans. In other words, they also need to be compliant on Oct. 1, 2013.
Q12: I have been reviewing the ICD-10-CM codes since I am responsible for implementation in my practice. Can you explain the seventh character extensions on the ICD-10 format?
A: ICD-10-CM has added alpha character extensions (seventh character) to codes in the appropriate sections to provide specific information about the characteristics of the encounter. For example, in the injury and external cause sections, the extension classifies an initial encounter, subsequent encounter, or sequela of an encounter. Extensions have different meanings depending on the section. A few common extensions are:
Extensions are also used to indicate trimesters of pregnancy:
1 First trimester
2 Second trimester
3 Third trimester
There are also extensions to indicate laterality:
Q13: Is there a big difference between ICD-9-CM and ICD-10-CM?
A: The differences between ICD-9-CM and ICD-10-CM are significant. Even though the format and structure remains primarily the same as ICD-9-CM, the specificity is much greater.
Q14: What is 5010? What is the relationship between 5010 and ICD-10-CM?
A: Version 5010 will replace 4010/4010A1 for electronic transactions. The compliance implementation date for 5010 for physicians is Jan. 1, 2012. Version 5010 will accommodate the ICD-10 code sets, and has an earlier compliance implementation date to ensure adequate testing time for the industry before moving to ICD-10-CM/PCS. Version 5010 addresses currently unmet business needs, including, for example, providing in institutional claims an indicator for conditions that were present on admission (POA). Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1.
Q15: Why should a small office purchase an electronic health record?
A: Implementation of the EHR or electronic medical record (EMR) is not mandatory. Each individual medical office will need to assess whether an EMR will benefit the practice with quality reporting and efficiency. Complete and thorough investigation into types of EHRs and their benefits and barriers is imperative when considering an EHR.
Q16: I have heard about AAPC’s ICD-10 Tracker recently. What is it and where can I find it?
A: The ICD-10 Tracker is available to all members. You must log into your member area on the AAPC website. Once logged in, on the top right corner of the screen is a heading ICD-10 Preparation with a stop and go light. You must select the size of your organization on the drop down list and click Save. You will be automatically directed into the implementation tracker. Implementation steps along with suggested timelines are listed on the tracker. After saving your ICD-10 Tracker, you will see a list of steps to keep you on track. By clicking on a step, you will be taken to a checklist of action items to complete for implementation.
After completing one of the actions, select the checkbox, and save your progress. You will be taken back to the list of steps on the tracker. If one of the actions is not applicable, select the checkbox and save. This alerts the system you have acknowledged the action and do not need to complete further action. The yellow lines by the track steps will start turning green as the actions are checked off. Steps have end dates. If one to two of these step end dates pass without all of the actions being checked off, then the progress light with turn amber warning you. If more than two of the step end dates pass without all of the actions being checked off, then the progress light will turn red warning you. There is a good illustration in the July 2010 Coding Edge. We created this tool to help the industry understand what steps are necessary when preparing for ICD-10.
Q17: Will current AAPC certified coders be required to be recertified to hold their credentials?
A: No, every AAPC certified coder will be required to take and pass an ICD-10-CM proficiency examination to validate their knowledge of ICD-10-CM. The exam will be an online 75-question, multiple choice exam, which will be available Oct. 1, 2012 through Sept. 30, 2014. The test will be open book, and any resources available to complete the exam may be used, including Internet, textbooks, or other materials. You must pass this examination to maintain certification. A certified coder will have two attempts at passing the exam for the $60 administration fee. Keep in mind other organizations not requiring a proficiency exam will require additional Continuing Education Units (CEUs) on ICD-10 coding and there are also fees involved in obtaining the additional CEUs.
Q18: Will AAPC have practice tests and a study guide available to prepare for the test?
A: Currently, we have the on-site and implementation boot camps, along with distance learning for implementation. We are working on additional training including general and specialty-specific ICD-10-CM/PCS coding training. We plan on creating several practice tests along with a study guide to ensure AAPC members are prepared for the transition.
Q19: I am a CPC® with three specialty credentials. Will I need to take three proficiency exams?
A: You will only be required to take one test regardless of how many credentials you hold.
Q20: Will the CMS 1500 claim form be updated to accommodate the new codes?
A: Yes, the CMS 1500 claim for will be revised in the near future to accommodate ICD-10-CM.
Q21: What steps should a professional coder be taking, and timeframes, for learning the new codes to obtain their recertification and proficiency?
A: Look to AAPC for training and education. Use the AAPC website and especially the member area to monitor your progress. We are planning training mechanisms and options from 2010-2014 and beyond. Distance learning, webinars, AAPC National Conferences, AAPC Regional Conferences, etc. Proficiency testing will begin Oct. 2012 and be offered through Sept. 30, 2014.
Q22: Will there be changes to CPT® coding?
A: CPT® and HCPCS Level II codes are not expected to change specifically due to ICD-10 related issues. CPT® and HCPCS Level II, however, will continue to be updated on their regular update schedule. Updates of these code sets should not be neglected due to the ICD-10 transition.
Q23: Will there be classes available to prepare for the AAPC test and will there be courses to learn how to use and code ICD-10-CM and ICD-10-PCS for coders and physicians through AAPC?
A: AAPC is developing for providers and health plans courses, distance learning modules, webinars on various topics, workshops, a three-day on-site curriculum, and 15-minute webinars for physicians and managers for ICD-10-CM training. The curriculum, courses, and education sessions will be taught by trained AAPC expert trainers. Our national and regional conferences will have many education sessions on various topics to assist in preparation for the exam. In 2013, the year of implementation, AAPC has planned eight regional conferences focused only on ICD-10-CM and ICD-10-PCS coving various topics for many specialties and health plans. Watch the AAPC website for updated information. Practice exams and other methods of education will be widely available to all persons involved in the health care industry to prepare for ICD-10-CM and ICD-10-PCS, and AAPC’s proficiency examination.
Q24: If our doctors consult a patient in an inpatient stay prior to Oct. 1, 2013, but the patient is discharged after Oct. 1, 2013, do we still use ICD-9-CM or following “discharge guidelines” by using ICD-10-CM?
A: For physician or non-physician practitioner (NPP) reporting, the date of service is reported. For example, if the physician sees the patient on Sept. 30, 2013 and discharges the patient on Oct. 2, 2013, the physician would use ICD-9-CM on Sept. 30, 2013 and ICD-10-CM codes on Oct. 1- 2, 2013.
Q25: I understand ICD-10-CM/PCS must be implemented by Oct. 1, 2013. Will there be a time prior to this date to submit the ICD-10-CM codes or will it be a 100 percent switch on one day?
A: There will not be a time period prior to ICD-10-CM implementation to submit claims before Oct. 1, 2013. The switch to ICD-10-CM will occur on Oct. 1, 2013 for all covered entities; however, your system vendors should test systems well in advance of implementation to ensure a smooth transition.
Q26: What is ICD-10-PCS and will I use in the outpatient setting?
A: ICD-10-PCS is a code set designed to replace Volume 3 of ICD-9-CM for inpatient procedure reporting. It will be used by hospitals and 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 (HIM) for CMS. ICD-10-PCS will not affect coding of physician or outpatient services. 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 71,000 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.
Q27: Is there an ICD-10 (provider coding) book available for purchase?
A: Many vendors are currently publishing ICD-10-CM code books. Ingenix is our training partner for ICD-10-CM/PCS training. AAPC offers a discount for the Ingenix books to our members. The codes will be updated yearly until implementation.
AAPC is working to provide a great deal of information to its membership to assist organizations in implementing this new system, and to use the new system once the compliance date approaches. Updates are posted to the AAPC ICD-10 website daily at www.aapc.com/ICD-10/. Please reference this website often for articles, information, and training options.
What is your most pressing ICD-10 question? Feel free to e-mail us and let us know.