Channel Sponsor - Coding/Billing/Collections

Sponsored by National Medical Billing Services | info@nationalASCbilling.com | (636) 273-6711

10 Myths and Facts About ICD-10

Healthcare facilities are right to be concerned about the path to ICD-10-CM/PCS implementation: Healthcare experts emphasize that providers have a lot of work to do to meet documentation requirements, adapt their software to the new codes and prepare for decreased billing productivity. CMS will require all health professionals and facilities to transition to ICD-10 by Oct. 1, 2013, when the current system will be expanded to add approximately 55,000 new codes.

The new coding system has come under fire in recent months, as the American Medical Association House of Delegates recently announced its opposition to the switch. AMA President Peter W. Carmel, MD, said, "The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patient's care. At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions."

Despite the AMA's opposition, CMS maintains that the 2013 implementation date for the new coding system stands. Here are 10 "myths and facts" about the transition to ICD-10, published by CMS and accessible through the agency's ICD-10 overview page.


1)
Myth:
Providers can consider the Oct. 1, 2013 compliance data for ICD-10 implementation "flexible."

Fact: All HIPAA-covered entities must implement the new code sets with dates of service that occur on or after Oct. 1, 2013.

2) Myth: Implementation planning should be undertaken with the assumption that HHS will grant an extension beyond the Oct. 1, 2013 implementation date.

Fact: HHS has no plans to extend the compliance data for implementation of ICD-10. All covered entities should plan to complete the steps required in order to implement ICD-10 on Oct. 1, 2013.

3) Myth: Non-covered entities that are not covered by HIPAA but use ICD-9-CM — such as Workers' Compensation and auto insurance companies — may choose not to implement ICD-10.

Fact: Because ICD-9-CM will no longer be maintained after ICD-10 is implemented, it is in non-covered entities' best interest to use the new coding system. The increased detail in ICD-10 is of significant value to non-covered entities, and CMS will work with non-covered entities to encourage their use of ICD-10.

4) Myth: State Medicaid programs will not be required to update their systems to use ICD-10-CM/PCS codes.

Fact: HIPAA requires the development of one official list of national medical code sets. CMS will work with state Medicaid programs to ensure the new coding system is implemented on time.

5) Myth: The increased number of codes in ICD-10-CM/PCS will make the new coding system impossible to use.

Fact: Just as the 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 doesn't necessarily make it more complex to use. In fact, the greater number of codes in ICD-10 makes it easier to find the right code. In addition, just as it isn't necessary to search the entire list of ICD-9-CM codes for the proper code, it is also not necessary to conduct searches fot he entire list of ICD-10 codes.

The alphabetic index and electronic coding tools will continue to facilitate proper code selection, and CMS anticipates that the improved structure and specificity of ICD-10 will facilitate the development of increasingly sophisticated electronic tools to assist in faster code selection. Because ICD-10 is much more specific, is more clinically accurate and uses a more logical structure, it is much easier to use than ICD-9-CM. Most physician practices use a relatively small number of diagnosis codes that are generally related to a specific type of specialty.

6) Myth:
ICD-10-CM/PCS was developed without clinical input.

Fact: The development of ICD-10-CM/PCS involved significant clinical input. A number of medical specialty societies contributed to the development of the coding systems.

7) Myth: There will be no hard copy of ICD-10-CM and ICD-10-PCS code books. When ICD-10-CM/PCS is implemented, all coding will need to be performed electronically.

Fact: ICD-10-CM and ICD-10-PCS code books are already available and are a manageable size (one publisher's book is two inches thick). The use of ICD-10-CM/PCS is not predicated on the use of electronic hardware or software.

8) Myth: ICD-10-CM/PCS was developed a number of years ago, so it is probably already out of date.

Fact: ICD-10-CM/PCS codes have been updated annually since their original development in order to keep pace with advances in medicine and technology and changes in the healthcare environment. The coding systems will continue to be updated until such time that a decision is made to "freeze" the code sets prior to implementation. For instance, the healthcare community may request that ICD-9-CM and ICD-10-CM/PCS codes not be updated on Oct. 1, 2012 and be frozen with the Oct. 1, 2011 updates.

If this freeze is approved through formal rulemaking, it would provide a year or more of stability and an opportunity to develop coding products and training materials. ICD-10-CM/PCS could then be updated again on Oct. 1, 2014, after providers have had a year of experience under the new coding system.

9) Myth: Implementation of ICD-10-CM/PCS can wait until after electronic health records and other healthcare initiatives have been established.

Fact: Implementation of ICD-10-CM/PCS cannot wait for the implementation of other healthcare initiatives. As management of health information becomes increasingly electronic, the cost of implementing a new coding system will increase due to required systems and applications upgrades.

10) Myth: Unnecessarily detailed medical record documentation will be required when ICD-10-CM/PCS is implemented.

Fact:
As with ICD-9-CM, ICD-10-CM/PCS codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for us when documentation doesn't support a higher level of specificity. As demonstrated by the AHA/AHIMA field testing study, much of the detail contained in ICD-10-CM is already in medical record documentation but is not currently needed for ICD-9-CM coding. 

Related Articles on Coding, Billing and Collections:
Pennsylvania Bills Would Expand Rate Hike Review to All Insurers
House Bill Would Increase Medicare Premiums for Wealthy Seniors
Medicare Saves Tennessee Residents $33M on Prescriptions

1) Myth: Providers can consider the Oct. 1, 2013 compliance data for ICD-10 implementation "flexible."

Fact: All HIPAA-covered entities must implement the new code sets with dates of service that occur on or after Oct. 1, 2013.

2) Myth: Implementation planning should be undertaken with the assumption that HHS will grant an extension beyond the Oct. 1, 2013 implementation date.

Fact: HHS has no plans to extend the compliance data for implementation of ICD-10. All covered entities should plan to complete the steps required in order to implement ICD-10 on Oct. 1, 2013.

3) Myth: Non-covered entities that are not covered by HIPAA but use ICD-9-CM — such as Workers' Compensation and auto insurance companies — may choose not to implement ICD-10.

Fact: Because ICD-9-CM will no longer be maintained after ICD-10 is implemented, it is in non-covered entities' best interest to use the new coding system. The increased detail in ICD-10 is of significant value to non-covered entities, and CMS will work with non-covered entities to encourage their use of ICD-10.

4) Myth: State Medicaid programs will not be required to update their systems to use ICD-10-CM/PCS codes.

Fact: HIPAA requires the development of one official list of national medical code sets. CMS will work with state Medicaid programs to ensure the new coding system is implemented on time.

5) Myth: The increased number of codes in ICD-10-CM/PCS will make the new coding system impossible to use.

Fact: Just as the 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 doesn't necessarily make it more complex to use. In fact, the greater number of codes in ICD-10 makes it easier to find the right code. In addition, just as it isn't necessary to search the entire list of ICD-9-CM codes for the proper code, it is also not necessary to conduct searches fot he entire list of ICD-10 codes.

The alphabetic index and electronic coding tools will continue to facilitate proper code selection, and CMS anticipates that the improved structure and specificity of ICD-10 will facilitate the development of increasingly sophisticated electronic tools to assist in faster code selection. Because ICD-10 is much more specific, is more clinically accurate and uses a more logical structure, it is much easier to use than ICd-9-CM. Most physician practices use a relatively small number of diagnosis codes that are generally related to a specific type of specialty.

6) Myth: ICD-10-CM/PCS was developed without clinical input.

Fact: The development of ICD-10-CM/PCS involved significant clinical input. A number of medical specialty societies contributed to the development of the coding systems.

7) Myth: There will be no hard copy of ICD-10-CM and ICD-10-PCS code books. When ICD-10-CM/PCS is implemented, all coding will need to be performed electronically.

Fact: ICD-10-CM and ICD-10-PCS code books are already available and are a manageable size (one publisher's book is two inches thick). The use of ICD-10-CM/PCS is not predicated on the use of electronic hardware or software.

8) Myth: ICD-10-CM/PCS was developed a number of years ago, so it is probably already out of date.

Fact: ICD-10-CM/PCS codes have been updated annually since their original development in order to keep pace with advances in medicine and technology and changes in the healthcare environment. The coding systems will continue to be updated until such time that a decision is made to "freeze" the code sets prior to implementation. For instance, the healthcare community may request that ICD-9-CM and ICD-10-CM/PCS codes not be updated on Oct. 1, 2012 and be frozen with the Oct. 1, 2011 updates.

If this freeze is approved through formal rulemaking, it would provide a year or more of stability and an opportunity to develop coding products and training materials. ICD-10-CM/PCS could then be updated again on Oct. 1, 2014, after providers have had a year of experience under the new coding system.

9) Myth: Implementation of ICD-10-CM/PCS can wait until after electronic health records and other healthcare initiatives have been established.

Fact: Implementation of ICD-10-CM/PCS cannot wait for the implementation of other healthcare initiatives. As management of health information becomes increasingly electronic, the cost of implementing a new coding system will increase due to required systems and applications upgrades.

10) Myth: Unnecessarily detailed medical record documentation will be required when ICD-10-CM/PCS is implemented.

Fact: As with ICD-9-CM, ICD-10-CM/PCS codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for us when documentation doesn't support a higher level of specificity. As demonstrated by the AHA/AHIMA field testing study, much of the detail contained in ICD-10-CM is already in medical record documentation but is not currently needed for ICD-9-CM coding.  

© Copyright ASC COMMUNICATIONS 2020. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Featured Webinars

Featured Whitepapers