Are you ready for the implementation of ICD-10-CM on October 1, 2015? Will your current documentation suffice when the diagnosis coding gets more specific? This article will give you some guidance to prepare for the new code set.
Frequently Asked Questions
- What is ICD-10?
ICD-10-CM stands for International Classification of Diseases, 10th Edition, Clinical Modification and contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases and ICD-10-PCS is for International Classification of Diseases, 10th Edition, Procedure Coding System a coding system for hospital use.
- Who has to use ICD-10-CM?
ICD-10-CM will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.
- When will ICD-10-CM/PCS be implemented?
ICD-10-CM/PCS will begin on October 1, 2015 and not before.
- Will this change the way we bill for our services and procedures?
No, the change to ICD-10-CM does not affect CPT (Current Procedural Terminology) coding for outpatient procedures and physician services.
There are many resources available to help you and your office transition from ICD-9 to ICD-10. One resource is the Centers of Medicare and Medicaid Services (CMS). After the last ICD-10 delay in 2014, CMS has certainly made an attempt to provide detailed educational material for physicians. Here you can find detailed ICD-10 help specific to cardiology and specific to the size of your practice. If you are just starting to get equipped for the ICD-10 implementation, check out the CMS Provider Resource page: https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
Here are some tips if you have not started the implementation process yet:
- Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and budget.
- Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans.
- Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT, and finance staff to coordinate on ICD-10 transition efforts.
You may be wondering what the costs are for ICD-10 Implementation. Survey results from Professional Association of Health Care Office Management state that the average expense for transitioning to ICD-10-CM is about $8,167.00 for a small physician practice. American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC) and the American Medical Association (AMA) have had similar results. The bulk of the costs come from training, purchasing manuals, software upgrades, and your superbill conversion from ICD-9 to ICD-10.
Here are several websites that offer information regarding ICD-10 Basics that you should start with:
AHIMA Implementation Tool Kit
What you can start doing immediately in your office is to compose a master list of where your office uses ICD-9 codes today, you can assess how and where you will need to make changes and provide education to be ready for the transition to ICD-10.
As you review your list, make sure you have accounted for the use of ICD-9 codes in:
- Physician orders
- Medical records
- Superbills/Encounter forms
- Practice management and billing systems
- Coding manuals
- Public Health Reporting
You can convert the ICD-9 codes that you use now to ICD-10 codes by using a number of available resources. CMS has developed GEMs (General Equivalency Mapping) which is similar to a crosswalk from ICD-9 to ICD-10. It is a tool you can use to convert ICD-9-CM to ICD-10-CM and vice versa, but it is not a one to one crosswalk. You can use the GEMs as a start and then follow up with the ICD-10 manual. You can purchase the ICD-10 manual or download the manual free on the CMS and CDC (Centers of Disease Control and Prevention) websites. Be sure to read the current guidelines for ICD-10 each year to keep up to date on any changes that may have taken place.
ICD-10 Codes and Guidelines
The National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), and CMS provide the "ICD-10-CM Official Guidelines for Coding and Reporting" using ICD-10-CM (Diagnosis Coding). These guidelines are a set of rules that accompany and complement the official conventions. Review the guidelines and the individual notes around your codes.
Cardiology Coding Changes You Will Find in ICD-10
There is no hypertension table in ICD-10 so be sure to review the specific hypertension codes and guidelines. When coding for acute myocardial infarction (AMI), the time frame between an initial AMI and a subsequent AMI has changed from 8 weeks to four weeks. Congestive heart failure and chest pain codes are much more detailed in ICD-10. Review these codes and guidelines and see if your documentation is as detailed. The ACC's April 2015 archived webinar on ICD-10 goes through these changes and others in a little more detail.
Resources for Cardiology in ICD-10
CMS has a specialty program for Cardiology to help you changeover to ICD-10. The "Road to 10" converts your common codes (from ICD-9 to ICD-10), goes over clinical documentation, and training resources.
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