ICD-10 delayed, but physician practices need to plan for expansion

At the Renal Physicians Association meeting this past weekend, attendees learned one reason why CMS has delayed implementation of the ICD-10 coding for medical procedures: there are thousands of new codes to become familiar with.

The Centers for Medicare & Medicaid Services announced on Feb. 14 that it would extend the implementation date for health care providers to begin using the new ICD-10 codes. CMS acting administrator Marilyn Tavernner said at the time that the agency would "re-examine the timeframe" for the planned Oct.13, 2013 launch. "There's concern that folks cannot get their work done around meaningful use, their work around ICD-10 implementation, and be ready for exchanges," Tavernner said, referring to health care insurance exchanges in the new health care reform law. "So we're trying to listen to that and be responsive."

There are two sets of codes that would be revised under ICD-10.

The ICD-10-CM
This set of codes identifies the diagnosis and will be used by physicians and other health care providers to report diagnoses in all settings. The total number of codes expands from about 13,000 to 68,000 codes.

The ICD-10-PCS
This is the code set that identifies inpatient hospital procedures only. There will be no change in the use of CPT and HCPCS in practice and ambulatory settings. The total number of codes expands from about 4,000 to 87,000.

Indeed, a review of the new codes lead by Nancy Spector, BSN, MSC, director of electronic medical systems for the American Medical Association, at the RPA meeting (download the slide here), showed what lies ahead: this increase in the number of codes will impact all specialties, including nephrology.

Those in renal care can empathize with the need for an update: similar to the recent makeover of the Conditions for Coverage after more than 40 years, the current ICD-9 coding system has been in place since 1979. Many of the codes are full; CMS has added sub codes (1.1, 1.2, etc.) as medicine has advanced and new procedures have been added for Medicare coverage. Spector said the current system has been unable to accurately reflect advances in medical knowledge or technology.

The ICD-10 has been around since 1989, originally developed by the World Health Organization. Aside from the expanded codes, it uses updated, current medical terminology and is more flexible in defining conditions while offering more specificity said AMA's Spector. It offers payers and clinicians an improved ability to assess the severity of illnesses, she said. ICD-10 also supports better data for quality, research, and data analysis and supports improved public health surveillance.

Getting ready

Even with the delay in implementation, nephrology practices need to begin reviewing their coding procedures now and figure out how the new codes will apply. Identify the top 10-30 codes you use now in your practice; start looking at the expanded ICD-10 codes that will be applicable. Then, "cross-walk" the two sets and see how your billing will change for those diagnoses.

With more codes comes more documentation, said Spector. "With a higher level of detail in ICD-10 coding, [payers] may require more detailed documentation," said Spector. "There will be greater detail needed about the patient's condition if you choose that higher level of code."

More complexity, more costs
The more complex codes will also require updating billing systems, and training staff on those system will be necessary; forms will change, and there will be down time preparing for the new coding. Payments to the practice may lag if the wrong codes are used for billing. Spector said the AMA expects "financial neutrality," but "we are watching and waiting to see if this happens."

For conditions involving the renal patient, coding will expand for those patients with chronic kidney disease and those on dialysis. Glomerular disease will have expanded codes, as will hypertension and other co-morbidities.

Get help

The AMA offers resources to help you train your staff on the ICD-10 codes. Go to www.ama-assn.org/go/ICD-10. The site includes ICD-10 FAQs, an article entitled, "Preparing for the conversion from ICD-9 to ICD-10: What you need to be doing today;" and an ICD-10 Fact Sheets series and checklist.