The How, What & Whys of ICD-10

By Alex Tate

October 1, 2015 might seem like any other date to the average American; however, anyone and everyone in the healthcare industry know this date will transform the current order of every practice’s operations. This is because the day will mark the beginning of the 10^th revision of the International classification of diseases – 1CD-10 diagnosis codes.

The version being replaced is ICD-9, the 9th revision of ICD, and contains about 13,000 outpatient diagnostic codes for medical billing; ICD-10 will have approximately 68,000. The whole dimensions of medical billings every practice will be altered and you’ll be required to make the necessary conversion in order to get paid.

Why are they replacing ICD-9?

The ICD-9 codes have become outdated as they’ve been around for an excess of 30 years. The diagnosis, treatment, procedure reporting and payment processes have considerably changed over time and now these codes are not as accurate a representation of those processes as they used to be.

Do I have to?

As providers are “HIPAA covered entities” and the switch to ICD-10 is a HIPAA requirement, doing so is mandatory for your practice. However, physicians aren’t the only ones who have to make the switch; being HIPAA covered entities, payers and healthcare clearinghouses must also do the same.

How are the codes changing?

Moreover, the three to five character formats of ICD-9 diagnosis codes limit the expansion of the code set. In contrast, the five to seven digit character format and mapping of the ICD-10 codes (a mixture of alpha and numeric characters) eradicates this problem and allows for a more advanced and specific diagnosis. With the ICD-10 codes, you can include a lot more detail within each code.

If this adjustment isn’t a big enough problem for physicians as it is,  you’ll be gutted to realize that there isn’t any significant correlation between the old and the new codes; meaning you’ll have to forget the old codes and adopt the new ones from scratch.

For example, 924.20 is the ICD-9 code for Contusion of foot. In ICD-10, here’s how this code has been expanded and posted:

Code                Description         

S90.30XA        Contusion of unspecified foot, initial encounter

S90.31XA         Contusion of right foot, initial encounter

S90.32XA        Contusion of left foot, initial encounter

Now the two important things to note here are one that the characters of ICD-9 and ICD-10 for contusion of foot have no identifiable correlation, and two that there are more specific codes for the diagnosis.

And what if I’m not ready by October 1, 2015?

Any claims containing ICD-9 codes after this date will not entertained or processed, and will be rejected. This will badly affect your payment, and in simple terms; you will require the ICD-10 codes to get paid. Thus, you need to be ready by the October 1, 2015 compliance date.  And by being ready to send and receive ICD-10 codes to and from payers, I’m referring to having the updated systems ready and by altering your workflows accordingly.

Okay, so how do I get ready?

The changes will take time and effort, but they’re achievable. To successfully do so without your practice incurring disruptions (both monetary and operational), here are the steps you must begin starting today to get ready for the changes in time:

You can’t get ready for the changes if your EHR or Practice Management (PM) vendor isn’t ready on time. Get in touch with your vendor and ensure that they’ll be ICD-10 ready before time; otherwise, start looking for a new vendor. Remember, you won’t get paid from October next year if your system isn’t using ICD-10 codes; so switch your vendor now if they won’t be ready on time.

Next, consult with your vendor (new vendor if you’re looking to switch), how to streamline the process for your practice with minimum disruptions. You also need to get in touch with payers, clearinghouses and billing company (if you’re using any) to ensure that their ICD-10 system and training upgrades and updates will be ready before time.

Once that is done, you must delegate a transition head for the ICD-10 adoption from within your practice. A suitable candidate would be a person who understands the operational and billing related aspects of your practice.

You need to make sure that he learns about ICD-10 through EHR and PM vendors, government-based training initiatives, and ICD-10 consultants (depending on your budget).  Subsequently, the training head needs to highlight the changes that your practice will face due to this conversion, identify methods to do so swiftly, and organize staff trainings.

Next, you need to conduct practice-level testing to ensure that you’ll be able to transact using ICD-10 codes. External testing with clearinghouses and payers follows to ensure that the transactions will earn help get you your money.

After reading this article you must have an idea of the immense significance of these updates and what you need to do to ensure that your practice does so swiftly. Again, the key here is to make a plan, get in touch with relevant personnel and start preparing early; because ICD-10 is coming despite your readiness. 

Alex Tate is a digital marketing specialist, content strategist, and a health IT Consultant at CureMD who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance.