With the transition from ICD-9 code sets used to report medical diagnoses and inpatient procedures to ICD-10 codes looming, a recent CardioSurve survey indicating that nearly 65% of cardiologists are unclear about the new requirements suggests greater provider education is needed.
The transition deadline, which was initially slated for October of this year, was delayed until Oct. 1, 2015 as part of the Protecting Access to Medicare Act that passed in April. The transition, which does not affect CPT coding for outpatient procedures and physician services, will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.
Given that the number of ICD-10 diagnoses codes will grow by nearly five times the number of ICD-9 diagnoses codes to 69,099, the Centers for Medicare and Medicaid Services (CMS) has urged health care organizations, from large national plans to small provider offices, laboratories, medical testing centers, and hospitals to allocate six to nine months for the transition. The shift will require significant changes to the way coding is done and organizations need to allow time to identify impacts; develop an implementation plan and timeline; work with vendors on new software and/or systems to accommodate the new codes; and coordinate with vendors, payers and other business partners to test transactions and processes.
The good news, according to the CardioSurve survey, is that nearly three out of four cardiologists have taken action to prepare for ICD-10. Furthermore, almost half (46%) have an ICD-10 implementation plan that they are about to enact or have already begun.
However, the details of the ICD-10 changes may require additional education since the majority of cardiologists indicated a poor understanding of the new requirements. The ability of clinicians and coding staff to select the appropriate diagnosis code was cited as the area of greatest difficulty in relation to ICD-10, followed closely by concerns about documenting the patient encounter (58%) and the ability to compare ICD-10 data to ICD-9 data (56%). The survey also suggests concerns about the financial impact of ICD-10, with 40% of cardiologists indicating the transition will likely have a negative financial impact and the remaining majority noting uncertainty.
The ACC is closely following CMS and industry efforts surrounding ICD-10 implementation and has developed several tools to help members both understand the ICD-10 requirements and plan accordingly. Additional resources will be posted as they are available. For more information, visit ACC.org/Coding.