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The Oct. 1, 2013 transition to ICD-10 will be a huge change for the health care industry. The current ICD-9-CM code set includes approximately 14,000 codes; ICD-10-CM will have more than four times that number. The additional codes will improve specificity for clinical information, which will have dramatic effects on revenue, daily operations, and documentation.

Consider the Impact to Your Practice
Unlike ICD-9-CM codes, which—with the exception of V and E codes—are wholly numeric, all ICD-10 codes are alphanumeric. Productivity will fall because coders will no longer rely solely on the number keypad to enter the codes, and will have to be careful to distinguish between similar-looking letters and numbers (for example, O vs. 0, Z vs. 2, and 1 vs. I). Also, many coders have memorized frequently used codes, or know exactly where in the ICD-9-CM book to find them. With ICD-10, seasoned coders will have to use the index again, and there are guideline changes to learn. Superbills are another concern. Physicians may now use superbills that are one or two pages in length.  With ICD-10, the number of pages may have to multiply significantly. In the future, such documents may no longer be convenient or even feasible for physician offices. By far, the most important challenge brought on by ICD-10 is the need for greater clarity and detail in providers’ documentation. Physicians won’t have to change the way they care for their patients, but they will have to change how they document that care. By  working to change documentation now, providers will be ready for the transition to ICD-10-CM.

Build Confident Documentation
Documentation requirements for ICD-10-CM will vary from ICD-9-CM documentation requirements in many cases. Working with your providers on clinical documentation improvement for ICD-10-CM through readiness assessments and education will help ease the transition. Readiness audits can be performed for your organizations by using internal or external resources.

AAPC Physician Services offers ICD-10 evaluations assessing whether your physician documentation is ready for ICD-10’s detail. These assessments not only identify your level of preparedness but, more importantly, provide valuable education on what is needed for ICD-10 specificity. This education provides the tools to start documentation behavioral changes resulting in confident ICD-10 billing.

Consider Examples of Documentation Specificity
To illustrate how you need to improve documentation specificity for ICD-10-CM code assignment, read the following examples:

1. There are many changes for diabetes coding. Most codes for diabetes are considered combination codes in ICD-10-CM. The elements that need to be documented to select the appropriate code are:

  • Type of diabetes
  • Body system affected
  • Complication or manifestation

For type II diabetes, a secondary code for long-term (current) use of insulin is required if the patient is using insulin. For example, E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy and Z79.4 Long term (current) use of insulin are used for a patient with type II diabetes mellitus with diabetic polyneuropathy who has a long-term (current) use of insulin.
2. Specificity for asthma is also increased in ICD-10-CM. Elements that must be documented include the severity of disease, such as mild intermittent; mild persistent; moderate persistent; severe persistent; acute exacerbation; status asthmaticus; exercise induced, cough variant, and other types of asthma. For example, J45.51 is used for a patient who has Severe persistent asthma with (acute) exacerbation.
3. Neoplasms will require specificity of site and laterality, in addition to the type; malignant (primary, secondary, carcinoma (CA) in situ). Secondary sites also should be documented as benign, uncertain, or unspecified behavior to meet code requirements. For instance, malignant neoplasm of the breast has 54 code choices in ICD-10. There are choices for both male and female, and an additional code for estrogen receptor status (if known) is required. As an example, C50.212 is appropriate for a patient with  Malignant neoplasm of upper-inner quadrant of the left female breast, and Z17.1 indicates Estrogen receptor status negative status [ER-].
4. Malunion fractures will have 2,000 codes to choose from in ICD-10. Clavicle fracture alone has 24 code choices.

Prepare Now for the Changes to Come
To prepare for ICD-10 you need to outline an implementation plan, change the  specificity of provider documentation, and get appropriate training. Here are some specific tips to get you started.

1. Make sure all staff is aware of the changes and how they will affect each area of your practice. Although it’s too early to begin code set training, now is the perfect time to begin general overview training and to formulate an understanding of ICD-10.
2. Look at provider documentation. Are they using a lot of unspecified codes? Do they currently give enough specific information to code using ICD-9 codes? These are areas you’ll need to improve upon.
3. Look at the top 50 diagnosis codes you currently use. You can do this by running a report on your system. Compare these to the equivalent codes in ICD-10 (very few codes will have a one-to-one conversion). The comparison will be helpful to  demonstrate how specific provider documentation will need to be to support the codes when the transition to ICD-10 occurs.
4. Perform either internal or external audits. Using your providers’ documentation, try to code the claims using ICD-10. This will quickly show where improvements in documentation are needed.
5. Educate, educate, educate. After performing the audits, be sure to share with providers the shortcomings you discovered, and what needs to be documented for ICD-10.