ICD-10-CM: Ready or Not, Here It Comes

If you’re gambling on another delay in the transition to the ICD-10-CM code set, it’s time to change your bet.

five-diceOn July 31, the U.S. Department of Health & Human Services (HHS) issued a rule finalizing October 1, 2015 as the compliance date for healthcare providers, health plans, and healthcare clearinghouses to implement ICD-10-CM. Although previous deadlines were moved “to allow insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready,” HHS has dubbed further delay of ICD-10 a myth, and announced  “no plans to extend the compliance date for implementation of ICD-10-CM/PCS; therefore, covered entities should plan to complete the steps required to implement ICD-10-CM/PCS on October 1, 2015.”

ICD-10-CM implementation is inevitable for several key reasons. Most significantly, the ICD-9-CM code set currently in use contains “outdated, obsolete terms that are inconsistent with current medical practice, new technology, and preventive services,” as stated in the July 2014 press release, and lacks the needed flexibility to keep up with changes. ICD-9-CM hasn’t received regular updates in several years. And because ICD-9 will receive no updates beyond 2015, even non-covered entities are best served by the transition to ICD-10.

ICD-10-CM has received limited updates since 2012, and regular (quarterly) updates will commence in 2016, thereby ensuring the code set remains up-to-date.

Skipping ICD-10 and holding out for ICD-11, as some have proposed, isn’t a viable solution. As reported in FierceHealthIT, ICD-11 isn’t expected to be ready for use for at least a decade, and perhaps much longer. The American Medical Assocations’s Board of Trustees estimates that ICD-11 won’t be available for use in the U.S. for 20 years, and expressed reservations about skipping ICD-10, stating that such a move “is fraught with its own pitfalls and therefore, based on current information available, is not recommended.”

The benefits of ICD-10-CM, as compared to ICD-9, have long been heralded. As expressed in a CMS press release:

By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services. The code set’s granularity will improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and provide detailed data to enhance health care delivery. Health care providers and specialty groups in the United States provided extensive input into the development of ICD-10, which includes more detailed codes for the conditions they treat and reflects advances in medicine and medical technology.

Many potential downsides of ICD-10 have been overstated or are simply false, as effectively demonstrated in ICD-10-CM/PCS Myths and Facts. For example, although the greater number of codes in ICD-10 relative to ICD-9 will allow greater specificity, it’s incorrect to assume that finding the correct code will be more difficult.

“Just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD-10-CM/PCS doesn’t necessarily make it more complex to use,” CMS argues. “In fact, the greater number of codes in ICD-10-CM/PCS make it easier for you to find the right code.” As well, “the improved structure and specificity of ICD-10-CM/PCS will likely assist in developing increasingly sophisticated electronic coding tools that will help you more quickly select codes.”

Some have argued that the proliferation of ICD-10 codes will spell the end of the superbill. But because most physician practices use a relatively small number of diagnoses related to their specialty, they can continue to use super bills containing the most common diagnosis codes reported in their practice, and supplement with additional tools.

Furthermore, the cost of ICD-10 implementation has been greatly exaggerated, causing widespread discouragement from starting training. Recent surveys have demonstrated costs could average only $3,500 per provider.

The bottom line is, it’s time to stop stalling on ICD-10 and ready yourself and your practice for the inevitable October 2015 implementation deadline.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 404 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

13 Responses to “ICD-10-CM: Ready or Not, Here It Comes”

  1. Katina Beane says:

    ICD-10 will have the most magnitude codes from the CM to PCS codes. I hope that all providers are ready for this change and embracing it get themselves ready.

  2. Alan K. says:

    At what point will ICD-10 replace ICD-9 on the CPC Certification exam? Assuming sometime in 2015, which Month? Should a new student just starting, bother to purchase an ICD-9 book?

  3. Brad Ericson says:

    January 1, 2016. We have to wait to assure it is implemented, and that won’t be until October 1, 2015. Because CPT and HCPCS Level II become effective January 1, that’s when we usually change the exams to reflect the new code year.

  4. Amy S. says:

    That is correct. They will continue to test with ICD 9 through till January of the following year of implementation. It is just like with the current exams. They can’t just drop everything to change an exam that far into the year. HOWEVER this will be a dozy of a change cause as I have witnessed at every exam I proctor there are still people bringing the wrong years books to take exams. In the case of some people bringing books that are 2 years out of date.

  5. MOTHI says:

    Please inform me if i will go for CPC exam on Jan 2015 which version of ICD,CPT,HCPCS books allowed for examination. Kindly reply.

  6. ashok kumar says:

    January 1, 2016. We have to wait to assure it is implemented, and that won’t be until October 1, 2015. Because CPT and HCPCS Level II become effective January 1, that’s when we usually change the exams to reflect the new code year.

  7. James Davis says:

    Two weeks before the last announced delay in the implementation of ICD-10, the head of CMS told an audience that there absolutely would be no further delay. The delay was not done because people were not ready, but because someone slipped the delay into a bill having to do with the Medicare fee schedule.

    Almost every article written since then announcing the new October 1, 2015 implementation date is followed by “subject to further delay by Congress.” No matter what CMS says or publishes, Congress has the authority to delay ICD-10 again. Many people in the healthcare industry are justifiably skeptical about October 1, 2015 as a “firm and final” implementation date.

    But if we get through March 31, 2015 without another announced delay, the odds are good that the implementation will happen.

  8. Anne Cicero says:

    I will believe it when I see it happen. My 2 year education in ICD9/10 completed in May 2014, so far has been a terrific waste of time and money.

  9. Juanita Hall-Disasi says:

    Is it true that all who holds a CPC certification will have to retake the whole exam over due to icd-10? I dont think its fair if so, CPC holders should just be trained on ICD-10 as anyone else and add a letter or number to the end of the creditial. For icd-9 will still be used for awhile and that should be recognized the whole 6-8 hour exam should not be taken over.

  10. Rajkumar Kuppuraj says:

    ICD-10 delay hurts the healthcare industry by prolonging the switch to a more modern and specific code system that will improve healthcare reporting, and even care itself. The longer the delay, the worse the impact.

    Thanks,
    Rajkumar Kuppuraj AHIMA Approved ICD 10 CM / PCS Trainer & Ambassador

  11. Deepak kumar says:

    As far my knowledge regarding ICD 10 News, from 1st october 2015, but yet their is no confirmation that ICD 10 will be started or not, it not only hamppering the Healthcare system revenue but also to many coders who want to get training for ICD-10-CM.

    Thanks & regards,
    Deepak kumar, CPC

  12. Mark Taylor says:

    Agree completely with James Davis’ comment from 11/7/14. It only takes one Congress Critter to get a push from the AMA (again) to slip the delay into an unrelated bill to trash I-10. Let’s just get it over with already before I-11 is upon us!

  13. Daryl Nache says:

    Say it isn’t so, aapc, that exams in Oct., Nov., and Dec of 2015 will still be testing on ICD-9?
    That is very sad, when I (and certainly many other instructors as well)- have been preparing students to test on “10” questions. If this is true, then all those that test during the balance of 2015 will have to also take the ICD-10 proficiency exam?
    This does not make sense when all claim forms as of Oct 1 will have to be coded in “10”.

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