While the compliance date for the mandatory switch from the current ICD- 9CM/PCS (International Classification of Diseases, 9th Edition, Clinical Modification/Procedure Coding System) to the new ICD-10CM is not until October 2013, now is the time for all therapists to start preparing for a smooth transition. ICD-9-CM codes will not be accepted for services provided on or after October 1, 2013, and ICD-10 codes will not be accepted for services prior to October 1, 2013.
Why the change is being implemented
The 30 year old ICD-9 CM system, despite the yearly updates, is outdated. It has not kept pace with current medical practice, and does not provide the necessary detail for patients’ medical conditions, or the procedures and services performed on hospitalized patients. The outdated and obsolete terminology still in place limits the use of its data for effective research. The system just no longer accurately describes the diagnoses and inpatient care procedures that are currently being delivered. In addition, the ICD-9 is running out of codes; hundreds of new diagnosis codes are submitted annually. Most European countries and Canada have already made the transition to ICD-10, which is owned by the World Health Organization. The ICD-10-CM is the United States’ modification of the ICD-10.
What the new ICD-10 system will offer
There is no doubt that the new classification system captures the advancements that have been made in clinical medicine, and provides significant improvements through greater detailed information and the ability to expand. ICD -10 incorporates much greater specificity and clinical information. ICD-10-CM will allow for more codes and better data tracking of incidence and prevalence of disease. Most believe that ICD-10-CM and ICD-10-PCS are technically superior, more logically organized, and they are unquestionably more detailed—by a factor of two in diagnoses (and twenty for injuries) and by a factor of fifty in procedures. As examples, under the current ICD -9 system, there are no codes to distinguish whether it is a right or left extremity that is fractured; this is corrected in ICD-10. Now, under the ICD-9-CM code for pressure ulcer codes, there are currently 9 location codes , none of which cover the depth or stage of the ulcer. In the ICD 10 Manual, there are now 125 codes for pressure ulcer codes. It is felt that the ICD-10-CM/PCS will enhance accurate payment for services rendered and facilitate evaluation of medical processes and outcomes. The superior detail offered should help reduce the number of cases where copies of the medical record need to be submitted for clarification for claims adjudication.
How To Prepare
Therapists in all settings will need to be trained in the new code sets. Hospital based therapists will need both ICD-10 CM and ICD-10 PCS training, whereas out-patient and private practitioners will only need ICD-10 CM updating. Private practitioners need to determine which key personnel needs the training and to what extent. All internal processes should be examined to see what will need updating. Any existing software for claims submission, billing and electronic medical records, including all “super bills” will have to be modified, or possibly replaced. Now is the time to find out whether you can upgrade your existing system or if you will have to buy a new one; do not wait until the last minute to negotiate this with your software vendor. For those who use outside billers or clearinghouses, find out now the specifics of their preparation/implementation for the transition, and whether any new costs associated with this will be passed along to you. Make sure you factor in time for internal and external testing of any new systems and reprinting of manuals and other materials ( there will be over 52, 000 new codes). Everyone realizes that this transition will be costly, take time, and probably result in initial decreased back office productivity. One simple way to get started is to prepare a comparison/crosswalk chart of ICD-9 to ICD-10 codes commonly used by occupational therapists. Anyone considering buying software of any kind in 2011 or 2012 should ask what provisions will be offered for the 2013 transition.
Here are some websites that provide solid user friendly information on ICD -10/CM/PCS:
- General ICD-10 Information
- ICD-10-PCS Coding System, Mappings, and Related Training Manual
- ICD-10-CM Coding System, Mappings, and Guidelines
- Report on Use of Health Information Technology to Enhance and Expand Health Care Anti-Fraud Activities
- CMS-0013-P—HIPAA Administrative Simplification:
Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS
- Transactions and Code Sets Regulations