ICD-10: How is it going to affect me?

Most providers of small practices don’t have the time or resource to fully understand how ICD-10 will impact them. In this article, I will explore this very important topic and provide suggestions for providers of how to prepare for ICD-10 compliance.

 The intention behind ICD is to provide a tool that would provide a more detailed, accurate code to match the actual diagnosis. The law states for all organizations covered under the HIPPA legislation there needs to conversion to ICD-10 by October next year. Prior to this, by January 2012, the HIPPA electronic transactions must be done using the 5010 electronic transactions version instead of the older 4010/4010A versions. If you are not familiar with this terminology, please check with your billing manger or practice management software vendor.

ICD-10 is divided into 2 areas: clinical modification (CM) and inpatient procedure coding system (PCS). Inpatient procedure codes are not affected. Outpatient codes are still represented under the current system.

ICD-10 is more specific on anatomical location, specificity of diagnosis, etc. To put this into perspective, take for example, if a patient was had a furuncle (boil) on the face and went to the dermatologist. The same patient then returned a few weeks later and had a carbuncle. In ICD-9, the same code would be used which is 680.0. In ICD-10 (specificity of the condition) would be recorded. The furuncle would be L02.92 and carbuncle would be L02.93. Furthermore, ICD-10 would enable you to record which encounter (initial versus subsequent).

The basic structure of the ICD-10 code is:

Characters 1-3: the category, 4-6: cause of problem, body part affected, severity of illness, 7: Place for extension of the code

Some EMR systems have a connection with live database and so a switch to ICD-10 will not affect the users when picking a diagnosis for their note. This is the case with Patagonia Health EMR. However, with EMRs that don’t have this link to the live database, the issue is how to migrate the codes into the system. A strategy would be to use transition tables which provide the ICD-10 equivalent to the ICD-9 code since there is no way to convert the codes. CMS and CDC are creating an Equivalency Mapping Tool mapping tool to assist the different stakeholders (clinical organizations, payers, etc.). One tool freely available on the web is ICD-10 Translator . Just plug in the ICD-9 code and it will convert it to the equivalent ICD-10 code.

This provides enough relevant background for most people about ICD-10 and the issues surrounding it. Please be sure to examine the table below that compares ICD-9 and ICD-10 codes. For providers, health care staff and administrators the important information to know is how to prepare for ICD-10. If you are using an EMR, the software vendor will be responsible for making sure that these codes are showing up. It may be done in an upgrade. If not, there are few tools I mentioned above.

The major implications for providers are two-fold. First, searching for the diagnosis within your EMR may be more cumbersome. EMRs depend on typing in keywords to look up the correct diagnosis. As ICD-10 codes are longer and more specific, there will be a need to use keywords in different combinations. For example, under ICD-9 “Infectious Diarrhea” is coded 009.2. The equivalent code under ICD-10 is A09 and under the keywords “Infectious Gastroenteritis and Colitis”. This seems like there will be a lot more work for the providers. However, there are 2 important points to consider. First, many systems remember frequently used codes and so next time you access them it will easier (this is called “machine learning”). Also, there will only be a set number of codes most providers use frequently so a favorite list can be created and you wouldn’t have to plug in multiple keywords frequently.

The second consideration is that providers need to document their notes more thoroughly to justify the more specific codes present in ICD-10 codes. Providers should make sure that they include certain descriptors are included such laterality (right/left), anatomical location, etc. even when though this information may not be necessary for clinical reasons. My recommendation would be to have the providers and billers to gain education about better documentation practices through educational forums by organizations such as HIMSS. Clinical Clinical Documentation Improvement Programs can also help, although this may be a more expensive approach.

In addition, the insurers will likely need to make changes in their coding rules and you should be aware of these changes as soon as your carriers share this information.

In conclusion, ICD-10 conversion will definitely have implications for providers, billing staff and the technology used. However, providers are not the only ones affected. All the different stakeholders in healthcare will need to make changes. In the end, ICD-10 can prove to be helpful in improving clinical documentation accuracy.  I hope that the tips, suggestions and ideas shared in this blog are helpful. Jitesh Chawla would say it is worth a trial. As we move closer to the target date for ICD-10 conversion, there will likely be new issues that come and I will cover those in upcoming articles.

  Table 1. ICD-9 and ICD-10 Comparisons