It's an exciting time of healthcare reform for the United States and a lot of that excitement revolves around the transition from ICD-9 to ICD-10. If you're asking yourself what is ICD-10 and why it is important, then you've come to the right place.
ICD-10 or a clinical modification of ICD-10 is the classification system currently being used by the majority of the world. The US is the only industrialized nation not using an ICD-10-based classification system.
ICD-10 matters to physicians because their documentation directly supports accurate code assignment in ICD-10. The greater specificity of ICD-10 will allow physicians to more accurately report the severity and complexity of their patients’ conditions.
There are two main reasons that the transition to ICD-10-CM/PCS is necessary:
ICD-10-CM is a clinical modification of the World Health Organization’s ICD-10, which consist of a diagnostics classification system. ICD-10-CM includes the level of detail needed for morbidity classification and diagnostics specificity in the United States. It also provides code titles and language that compliment accepted clinical practice in the US. The system consist of more than 68,000 diagnosis codes.
ICD-10-PCS was developed to capture procedure codes. This procedure coding system is much more detailed and specific than the short volume of procedure code included in ICD-9-CM. The system consists of 87,000 procedure codes.
Together ICD-10-CM and ICD-10-PCS have the potential to reveal more about quality of care, so that data can be used in a more meaningful way to better track the outcomes of care. ICD-10-CM/PCS incorporate greater specificity and clinical detail to provide information for clinical decision making and outcomes research.
There are many reasons why the transition to ICD-10 is important. ICD-10 will provide us with:
Additionally the benefits of ICD-10 outweigh the costs.
An independent study conducted by RAND concluded that the benefits of ICD-10-CM/PCS are likely to exceed initial implementation costs within just a few years. Furthermore, the cost of doing nothing may be greater than the actual implementation. Any delay in adoption of ICD-10-CM/PCS will cause an increase in future implementation costs as the management of health information becomes increasingly electronic and the costs of implementing new coding systems increase due to required systems and application upgrades.
There are a number of areas within the ICD-9-CM where the country could benefit from the greater detail provided by having more extensive codes. While there is greater specificity offered in the majority of the ICD-10-PCS codes, there will continue to be options for broader, generalized codes when the specific details regarding a patient's condition may not be known or documented. Additionally, the ICD-9-CM classification has not kept up with medical knowledge. Some examples are as follows:
Example: ICD-9-CM does not accurately reflect current technology and medical treatment. Since ICD-9-CM does not accurately describe advancements in technologies, significantly different procedures are assigned to a single ICD- 9-CM procedure code. Limitations in the coding system translate directly into limitations in coverage and reimbursement.
Example: CMS has had difficulties identifying and paying for new technology. This has been a particular problem in the cardiovascular and orthopedic parts of ICD-9-CM where many categories have no room for more ICD-9-CM codes. Some of the recent problems have included new devices used in spinal fusions, new cardiac defibrillator devices, and drug eluting stents, among others.
Accurate code assignment in ICD-10 requires accurate and complete documentation from physicians. The greater specificity and clinical accuracy contained within ICD-10 allows for more precise reporting of the patient’s condition(s). With the growing emphasis on linking quality and payment, and the movement toward value-based purchasing, the additional clinical detail that can be captured with ICD-10 is going to be necessary. To prepare for ICD-10, physicians must ensure that their documentation is accurate and complete.
ICD-10-CM/PCS Documentation Tips
Myths of ICD-10-CM/PCS
Frequently Asked Questions about ICD-10-CM/PCS
Misperceptions, Misinformation, and Misrepresentations: The ICD-10-CM/PCS Saga
Clinical Documentation Guidance for ICD-10-CM/PCS
Bird's Eye View of ICD-10 Documentation Gaps
ICD-10 Coding Basics(You Tube video with CMS)
Transitioning a Physician Practice to ICD-10 (Note: this article was published in 2012, There for referencing the 2014 implementation date)
Electronic Documentation Templates Support ICD-10-CM/PCS Implementation
Top Documentation Issues for ICD-10
It's time to start implementing ICD-10. Choose your position in healthcare to get your ICD-10-CM/PCS implementation needs.
You are the resource physician that many offices have who provides advice and guidance to your staff on coding and billing issues.
Group 1 processes related to assigning and/or auditing ICD-10-CM codes including the coding process, processes such as requests for ICD-10-CM codes included with orders for lab and imaging, pharmacy benefits, etc., and regulatory compliance process.
Focus should be on obtaining foundational knowledge of ICD-10-CM and understanding how ICD-10-CM is different from ICD-9-CM.
Group 3 processes require knowledge of ICD-10-CM codes and are not Group 1 or Group 2 processes and functions.
Go to the full implementation model for the Physician's Office
These examples show how easily physician practice superbills can be converted to ICD-10-CM.
ICD-10 Superbills: Example 1 Example 2
AHIMA's online ICD-10 Documentation Principles and Practice provides an overview and bite-sized, self-paced training modules that doctors can access anytime, from any device. The program customizes learning by delivering three- to five-minute modules that cover each physician's most billed diagnoses and conditions, making the learning targeted and highly relevant.
AHIMA's Clinical Documentation for ICD-10 by Specialty: Principles & Practice online training platform was specifically designed with the needs of the physician and physician practices in mind. Written by physicians, CDI specialists, and medical coding experts, the program includes the following features:
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Ensure your coding staff is trained for ICD-10.
Experience a dynamic training program that teaches proficiency in the ICD-10-CM coding system and prepare to train other coding professionals in this system. Please note that stand-alone ICD-10-PCS programs are not offered separately. Students interested in learning diagnosis and procedure coding should register for ICD-10-CM/PCS: Building Expert Trainers in Diagnosis and Procedure Coding.
The AHIMA Academy for ICD-10-CM begins with a self-paced online course (completion is required prior to in-person training), and continues with two days of in-person training. The online course provides basic training in the ICD-10-CM code sets, and is conducted on AHIMA’s remote Web-based Distance Education Campus. At the in-person workshop, trainers focus on in-class intermediate and advanced ICD-10-CM coding exercises while modeling training techniques. After successful completion of both the online and in-person training portions, attendees may complete an assessment in order to earn an AHIMA ICD-10-CM Trainer Certificate.
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AHIMA’s onsite workforce training allows organizations to train for ICD-10 CM/PCS at their own location. AHIMA subject matter experts will train HIM and other staff members for either CM or CM/PCS during a time that best suites the training needs of the organization. Organizations with a large number of staff can easily train by rotation allowing the continued day to day business to remain uninterrupted. Requests for onsite workforce training can be made here.