ICD-10 Update

By Caitlin Lukacs

Though the ICD-10 deadline has been pushed back a year—to Oct. 1, 2014—it’s still important for doctors of chiropractic (DCs) to begin preparing for this transition. If you haven’t already, now is the time to start contacting your clearinghouses, billers and practice management system operators, while training your staff on the new ICD-10 codes.

“There’s definitely still time—we’re not in panic mode yet,” says Steven Zobell, vice president of product development, who is heading up the ICD-10 initiative for ADP AdvancedMD—a business outsourcing and human capital management solutions company offering services in human resources, payroll, talent management, tax and benefits administration solutions. “But doctors should start putting the pieces in place for the transition so that they have plenty of time to train and test their new systems and procedures. It’s always better to be proactive,” he continues.

What Are ICD-10 Codes?
The International Classification of Diseases 10th Edition (ICD-10) codes fall into one of two categories: ICD-10-CM for diagnosis coding and ICD-10- PCS for inpatient procedure coding. ICD-10-CM was developed by the Centers for Disease Control and Prevention (CDC) for use in all health care treatment settings, while ICD-10-PCS was developed by the Centers for Medicare and Medicaid Services (CMS) for use only in the hospital inpatient setting.

Though the codes are updated every year, the transition from ICD-9 to ICD-10 is different in that the structure of the codes will also be changing. ICD- 9 codes are mostly numeric and are made up of three to five digits. ICD-10-CM codes, on the other hand, are alphanumeric and are made up of three to seven characters, of which the first character is alpha and the second is numeric. The remaining one to five characters could be either alpha or numeric.

The reason for this transition, according to CMS, is “ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice.” Not only will ICD-10 codes allow for more specificity in describing a patient’s diagnosis and in classifying inpatient procedures, but they will also “accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing.”

Additionally, there is not a simple one-to-one match between ICD-9-CM codes and ICD-10-CM codes. There are many reasons for this difference, including new concepts in ICD-10 that are not present in ICD-9, multiple ICD-10 codes for a single ICD-9 code and multiple ICD-9 codes for a single ICD-10 code.

Because ICD-10-CM/PCS codes will allow providers to report greater specificity of clinical information, there are many more codes than were included in ICD-9. In fact, for diagnoses, there are 14,025 ICD-9-CM codes and 68,069 ICD- 10-CM codes, and for procedures, there are 3,824 ICD-9-PCS codes and 72,589 ICD-10-PCS codes.

Easing the Transition
To help with the transition, general equivalence mappings (GEMs) will be available to assist in translating data from ICD-9-CM to ICD-10-CM. The GEMs are a comprehensive translation dictionary, but they are more complex than a simple one-to-one crosswalk. Therefore, it is important that you learn how to look up codes under ICD-10.

ADP AdvancedMD has created the following timeline of four steps to be taken to ensure that your practice is on track for the ICD-10 transition.

Phase 1: Educate, Assemble and Organize an ICD-10 Team

The first thing a DC should do is to determine how the transition will affect his or her office. For example, will it be necessary to work with new business partners or vendors? Next, organize an ICD-10 implementation team with staff from key areas such as coding, billing, clinical and IT. Choose one person to be the ICD-10 transition leader.

Phase 2: Identify, Assess, Plan and Approve

Zobell suggests starting phase 2 by asking which ICD codes are used most frequently in the office. How will they change? And will the documentation process need to be altered at all? From there, prepare an initial budget and timeline for training and implementation. “Try to be ready for the training and testing portion of your transition around Jan. 1, 2014,” notes Zobell. “These phases will take time, and you’ll likely go through multiple iterations of testing so the more of 2014 that you’re able to devote to this, the better,” he says.

Phase 3: Execute Training Plans

During this phase, you’ll need to ensure that any physicians, providers and clinical staff members are familiar with, and trained on, any workflow and documentation changes that will occur because of the ICD-10 switch.

Phase 4: Testing

This phase will most likely take up the largest chunk of your timeline. During this time, you’ll need to determine if each workflow process is working as designed and if the communication between your office and your business partners, payers and vendors is functioning at the highest level.

For more information on ADP AdvancedMD’s resources for ICD-10 implementation, including its extensive timeline and trail map, visit MyICD10.advancedmd.com.

Strict Deadline
The ICD-10 deadline is rigid. All HIPAA covered entities must implement the new code set with dates of service that occur on or after Oct. 1, 2014. You will not be able to report ICD-9-CM codes after this date. However, if the date of service was before Oct. 1, 2014, you will use ICD-9 to code the diagnosis.

CMS gives the following example to help explain when to use which coding system:

A patient has an appointment on Sept. 27, 2014, and is diagnosed with bronchitis. The patient returns for a follow-up appointment on Oct. 3, 2014. In this case, a practice will submit a claim with an ICD-9 diagnosis code for the first visit and another claim with an ICD-10 diagnosis code for the follow-up visit.

ACA will continue to provide up-to-date information and resources in its publications and online. Questions may be directed to the Insurance Relations Department at insinfo@acatoday.org.

ACA also has a website for ICD-10 resources, which can be found at www.acatoday.org/ICD10. Please check this webpage frequently, since resources will be added as the ICD-10 deadline approaches.

Additional Resources


Published in the August 2013 ACA News.