Introduction to the New ICD-10 Coding

Healthcare Training Resource
September 20, 2012 — 880 views  
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The transition to ICD-10 has implications for virtually the entire health care industry. Hospitals, healthcare providers, third-party payers and patients will be affected, as well as private and public research institutions and oversight agencies. Even banks and the United States Treasury will feel the effects of the change.

Upgrading to ICD-10 is a requirement of the Health Insurance Portability and Accountability Act and must be completed by Oct. 1, 2013. ICD-10 reflects better uniformity among healthcare providers when reporting procedures and diseases. The current reporting system, ICD-9, has been used for more than 30 years.

The number of diagnosis codes expanded from 14,000 in ICD-9 to over 68,000 in ICD-10; procedure codes expanded from 4,000 to 87,000. Additionally, the codes increased in length and are alphanumeric. This will necessitate software upgrades or replacement to accommodate changed data fields.

With the expanded number of codes, diagnoses are more specific. This means healthcare providers will have to be more detailed in their patient notes and billing coders will have to be trained to look for the extra specificity.

There are several things you can do to prepare for a smooth transition to ICD-10.

*Find out when your billing software vendor, billing service or clearinghouse will upgrade or begin using the ICD-10 codes. Check whether existing contracts cover the upgrades.

*Find out when third-party payers will start accepting the ICD-10 codes. Payers will transition to ICD-10 at different times; create procedures to accommodate ICD-9 and ICD-10 billing during the transition period.

*If you use an electronic health record system, check with the vendor to see when the updates will be available for the billing and practice management modules of the EHR. Determine if you will need to modify any forms or reports to accommodate changes in data fields.

*Educate your staff, including physicians and nurses, on the documentation needed to reflect the greater specificity in diagnosis codes. Determine your most frequently used diagnosis codes, and compare current documentation to the documentation required under ICD-10. 

*Identify changes needed on hard-copy billing forms such as superbills.

*Determine how long you will need to retain the ICD-9 system for claim resubmission, data analysis or research.

*Conduct internal and external tests of your software. 

In addition, in ICD-10 some medical conditions have been regrouped, headings changed and chapters rearranged. Coders and billing specialists need to become familiar with the new layout of the coding books.

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