ICD changes coming in 2013
The world of medical coding will go through a major change in a little more than two years, when ICD-9 diagnosis and procedure codes will be replaced by ICD-10 codes, a major conversion that will be discussed during two sessions today and Wednesday.
A look at the changes will be presented from 2:30 to 3:30 p.m. today as "ICD-10" in Room 143B. A second session, "Coding Pitfalls Now and in the Future, Hello ICD-10!" will be presented from 8:40 to 9:10 a.m. Wednesday in Room 202A.
Both sessions will review the basics of the switch, which takes effect Oct. 1, 2013, said presenter Sydney V. Ross-Davis, M.D., medical director II for Blue Cross and Blue Shield of Illinois, and the ICD-10 Health Care Management program lead for Health Care Service Corporation (HCSC).
"ICD-10 is coming and it is a HIPAA-mandated change to how providers, both institutional and professional, communicate with payers and each other," Dr. Ross-Davis said. "We need to plan to make that transition to this new code set. Every health care service with a date of service after October 1, 2013, must be coded using ICD-10 codes."
ICD-10 has 69,000 diagnostic codes, up from 13,000 in ICD-9. There are 72,000 ICD-10 procedure codes (PCS), up from 11,000 ICD-9 PCS codes. These codes are used by health care providers to communicate data about patients to reporting agencies, insurers, medical records and other clinicians.
"The key things to know are that ICD-10 is far more granular and far more clinically structured than ICD-9," Dr. Ross-Davis said. "It does require that you make some changes in the way you document, and it requires that you understand the changes in the code set and are prepared for the changes in the codes with updated tools, updated processes and retrained coding/office staff."
The change will not be a simple upgrade because not only are there more codes in the ICD-10 set, but the terminology is different, more detail is required and some codes have been moved to different sections, she said.
"In an inpatient setting, where you must use ICD-10 codes for diagnosis and procedures, you must document in a manner that allows coders in your institutional setting to translate your diagnosis and/or procedures into an appropriate claim to document the services you are delivering," Dr. Ross-Davis said. "For outpatient services, physicians will continue to use CPT codes for their procedures, but they still will have to use ICD-10 diagnosis codes for all the diagnoses.
"There is no automatic crosswalk between ICD-9 and ICD-10. There is no one-to-one correlation. There is only a translation, and it is like going from speaking in Latin to speaking in Esperanto. Remember, ICD-9 is 30 years old. We have new diseases, new procedures and a different understanding of some diseases since ICD-9 was introduced."
With the implementation of ICD-10, the coding process will be restructured so health care professionals first indicate an anatomical site and then disease entity or injury affecting that anatomical site, Dr. Ross-Davis said.
A key in the switch will be to understand the differences in the codes. Also, using an electronic health record (EHR) system that can accommodate the ICD-10 codes would help, she said.
"You have to make sure that regardless of where you are right now with your office, whether it is EHR or paper, if you choose to use EHR software, you must make sure it is ANSI version 5010-compliant and ICD-10 enabled. Your vendor needs to be able to tell you that is the case," Dr. Ross-Davis said.
The new codes will give the health care system more data that can be used to improve public health and research capabilities, demonstrate outcomes and support new health care delivery models.
"Your medical records must demonstrate good documentation, as you were taught in medical school, and then that documentation must be translated into ICD-10 code that goes to the payers, the quality review organizations, the patient's medical record and the EHR," Dr. Ross-Davis said. "On a long-term basis, you must be able to express, in a language that these entities will understand, what occurred in the office, the hospital or any setting, with your patient."