ICD-10 - What Every Physician Needs to Know!

What is ICD-10?

ICD-10 is a classification system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is in almost every country in the world, except the United States.

What are ICD-10 CM and ICD-10 PCS?

When we hear “ICD-10” in the United States, it usually refers to the U.S. own version, or Clinical Modification of ICD-10: ICD-10-CM. This code set is scheduled to replace ICD-9-CM, our current U.S. diagnostic code set, on Oct. 1, 2014.

You will also hear ICD-10-PCS, for “Procedural Coding System,” is will also be adopted in the United States. ICD-10-PCS will replace Volume 3 of ICD-9-CM as the inpatient procedural coding system. CPT® would remain the coding system for physician services for outpatient procedures.

Why is the United States moving to ICD-10-CM?

ICD-9-CM has several problems. First, it is out of room. Because the classification is organized scientifically, each three-digit category can have only 10 subcategories. Most numbers in most categories have been assigned diagnoses. Medical science keeps making new discoveries, and there are no numbers to assign these diagnoses.

A new, more detailed codes of ICD-10-CM, will allow for classification of disease patterns and treatment outcomes that can advance medical care.

How is ICD-10 better?

Many improvements have been made to ICD-10-CM. For example, a single code can report a disease and its current manifestation (i.e., type II diabetes with diabetic retinopathy). Likewise, the trimester is designated in obstetrical codes.

The increase in availability of specific codes allows a better description of the characteristics of the patient getting the diagnosis, as well as the laterality of the body (ie, on the left arm). In contrast, ICD-9 did not require these elements, and the physician had to deal with language such as "unspecified," "not elsewhere classified," or "other" that said nothing about the patient.

ICD-10 added a lot of diagnoses that we now encounter but were not even known in the 70s. The list also includes little-used diagnoses, which makes it more compatible with modern medicine.

  

ICD-10 offers Improved Description of the Extent of Diagnoses to capture the breadth and depth of your patients' diagnoses. The increased specificity and reduced ambiguity of ICD-10 will actually make coding language closer to normal language.

How are CPT and HCPCS codes affected?

Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are not a part of this transition.

There are a lot more codes in ICD-10, isn’t that a problem?

No, quite the contrary. Just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD-10-CM/PCS doesn’t necessarily make it more complex to use. In fact, the greater number of codes in ICD-10-CM/PCS makes it easier to find the right code. In addition, just as nobody memorizes or knows the entire list of ICD-9-CM codes for the proper code, it is also not necessary to memorize or know the entire list of ICD-10-CM/PCS codes. The increased number of codes increases the level of specificity a particular condition can be described.

Is detailed medical record documentation required when ICD-10-CM/PCS is implemented?

As with ICD-9-CM, ICD-10-CM/PCS codes should be based on medical record documentation. ICD-10 is a new classification and there will be need to clarify the documentation to allow capture of the correct disease process. This is already occurring in ICD-9 and will continue in ICD-10 with focus on the new concepts.

Why do I care about the ICD-10 codes?

Your words and documentation are translated into data. That data is then used by payers and CMS to create a quality profile for each provider. Physicians have every interest to make sure that the data accurately reflects the disease state of your patients. As the US healthcare system moves from Fee-per-service to Fee-per-performance, the quality profile will determine future physician payments. It is important to accurately capture the patients’ co-morbidities and specific conditions. They are the basis for risk adjustment calculations.

When will ICD-10-CM and ICD-10-PCS be implemented?

The Centers for Medicare and Medicaid Services (CMS) announced in January of 2009 that ICD-10-CM and ICD-10-PCS will be implemented into the HIPAA mandated code set on October 1, 2014.

What should physicians do to prepare for the transition to ICD-10?

In their offices, providers should plan to test their ICD-10 systems early, to help ensure compliance. Beginning steps in the testing phase include: Internal testing of ICD-10 systems, Coordination with payers to assess readiness and project plan launch by data management and IT teams.

While working in the hospital, physicians are requested to provide the most complete documentation that captures the patient’s condition and severity of illness. Also, physicians have resources within Via Christi who can help them with the transition. Via Christi has developed an ICD-10 page with a vast list of resources. The CDI (Clinical Documentation Integrity) staff is another valuable support to physicians. The queries left on the chart are intended to help physicians accurately describe their patients. You will be helping yourself by answering those.

What is the grace period for the use of ICD-9 codes submitted after implementation of the new ICD-10 codes?

CMS has indicated in their FAQ's that there will be no delay in implementation of ICD-10.