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ICD-10 is coming; are you ready?
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On Oct. 1, the U.S. health care system will begin to use the International Classification of Diseases 10th edition ─ it replaces the decades-old 9th edition. This represents the largest change in coding since the revision of evaluation and management CPT codes in 1992.
According to a blog post by William D. Rogers, MD, FACEP, ICD-10 Ombudsman at CMS, ICD-10 promises to help physicians and other health care providers better coordinate care, keep more detailed records and more accurately define patients’ clinical conditions, as well as implement new payment methods. It will also allow for data comparisons between regions of the United States and the rest of the world, and may help improve clinical and surgical practice guidelines across the entire spectrum of health care services.
Kevin J. Corcoran, president of the Corcoran Consulting Group, which has so far trained more than 6,100 physicians and staff in ICD-10, said in an interview that he expects it will launch on Oct. 1, 2015.
“Despite all the delays, this time, it really is going to happen,” Corcoran said. “So, you need to get ready. Are your practice-management systems, route slips and staff prepared to use these codes in October? If not, then you have to move quickly to adapt to this major transformation.”
Corcoran added, “This rollout is likely to be bumpy for the first few months, with slower payments and many unsatisfactory claims due to inaccurate ICD-10 codes.”
Illustrating the challenges associated with switching to ICD-10, Corcoran pointed to the last two countries to adopt it — Australia and New Zealand. He noted that about half of all medical records were too cryptic, brief or ambiguous to permit selection of an ICD-10 code. Physicians had to amend or replace their impression and/or diagnosis to allow billers to code it.
“ICD-10 requires more detail,” Corcoran said. He recommends physicians incorporate laterality, etiology, manifestations, comorbidities and greater specificity in their notes. Without this detail, claims submission is arrested pending further information from the ophthalmologist. For example, if a physician notes “glaucoma” in a chart, there isn’t enough information to select an ICD-10 code. What’s missing? The type of glaucoma (i.e., open-angle or narrow-angle). The severity (i.e., mild, moderate, severe). The eye (i.e., right, left, both).
“The biller cannot simply guess these things,” Corcoran said.
“The transition to ICD-10 will likely take a few years, and CMS will not be very strict in the first year,” Corcoran said. He added, “This is more complex than some people believe, and requires more detail than some people imagine, so there are a lot of ways to stub your toe.”
According to Corcoran, with all its challenges, the change to ICD-10 must be taken very seriously. — by Jason Laday
More information on ICD-10 can be found here:
www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10