October 1st, 2014 is the cut-off for all
physicians and insurers to switch over to ICD-10 from ICD-9. The International
Statistical Classification of Diseases & Related Health Problems (ICD) is a
medical classification list created by the World Health Organization. Its
purpose is to use codes to identify known diseases and other health issues. ICD
also helps with the retrieval and storage of diagnostic information and will
classify and code all diagnoses, procedures, and symptoms that are recorded in
conjunction with hospital care. The transition to ICD-10 is taking place
because data about patients’ medical conditions and hospital inpatient
procedures on ICD-9 is limited. This change will affect everyone covered by the
Health Insurance Portability Accountability Act (HIPAA).
For most, ICD-10 coding has been used for years, but the
push will ensure every United States practice is uniform. Those who do not code
correctly after the October 1st deadline will face penalties
including denial of claims, which will likely force them to re-submit. This
will dramatically slow reimbursement times and cash flow, leaving physicians’
offices with major operational inefficiencies. The ICD-10-CM revision includes more
than 68,000 diagnostic codes, up from a previous 13,000 codes in IDC-9-CM,
allowing physicians to provide more specific details in documentation. ICD-10
will provide details to ensure that reimbursements match the level of care
actually given, along with accuracy in patient documentation to allow improved
care. Changes to be aware of include laterality, disease pathophysiology,
combination codes, encounter timing, identification of trimester, increased
disease specificity, alcohol and drug abuse, expansion of injury codes, and
post-procedure disorders.
Healthcare IT professionals can prepare for this change through
an ICD-10 impact assessment by identifying systems, applications, and software
that currently uses ICD-9 code and evaluating each step to see where ICD-10
codes will be needed. They should talk with their software and service vendors
to get the conversation going about where they are in their transition to
ICD-10, asking questions such as: How does this impact the software? Where are
you in the transition process? How are
we going to reach full compliance? Training, coordination, and education to
prepare for ICD-10 are very important. A clinical documentation improvement
(CDI) documentation gap analysis should also be applied to super bills, charts,
etc. Once a good ICD-10 impact assessment is completed, an accurate budget can
be planned. Although some might struggle with the switch at first, once
implemented, ICD-10 is expected to improve quality measures, reporting, and
regulatory compliance.
Watch out for this one. Senate passed a bill that would delay the implementation of ICD-10 so it may not be going live on October 1st as planned. Still awaiting Presidential signature but definitely something to be aware of.
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