ICD-10 FAQs for Doctors

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1 ICD-10 FAQs for Doctors What is ICD-10? ICD-10 is the 10 th revision of the International Classification of Diseases (ICD), used by health care systems to report diagnoses and procedures for purposes of reimbursement and health tracking. The ICD-10 codes describe diseases and injuries, identify signs and symptoms for research, depict why a patient is seeking medical services, and offer a consistent standard for billing and payments. When is the conversion to ICD-10 happening? The federally mandated conversion from the currently used ICD-9 to the revised ICD-10 will occur in the U.S. on October 1, ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1. Can we start using ICD-10 early? No. Claims for services provided before October 1, 2015, must use ICD-9 diagnosis and inpatient procedure codes. Why is the change happening? The health care industry is making the transition from ICD-9 to ICD-10 because: ICD-9 is 30 years old, it has outdated and obsolete terms, and is inconsistent with current medical practices. ICD-9 codes provide limited data about patients medical conditions and hospital inpatient procedures. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. Because the classification is organized scientifically, each three-digit category can have only 10 subcategories. Most numbers in most categories have been assigned diagnoses. Medical science keeps making new discoveries, and there are no numbers to assign these diagnoses. ICD-10 codes allow for greater specificity and exactness in describing a patient s diagnosis and in classifying inpatient procedures. ICD-10 coding will make the billing process more streamlined and efficient, and this will also allow for more precise methods of detecting fraud. ICD-10 will also accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing. What is the difference between ICD-9 and ICD-10? ICD-9, which has been being used in the U.S. for the past 30 years, has 17,000 codes. ICD-10 has more than 140,000 codes. This increased number of codes allows for much greater specificity in documentation. For example, a single code can report a disease and its current manifestation (i.e., type II diabetes with diabetic retinopathy). In fracture care, the code differentiates an encounter for an initial fracture; follow-up of fracture healing normally; follow-up with fracture in malunion or nonunion; or follow-up for late effects of a fracture. Likewise, the trimester is designated in obstetrical codes. Many ICD-10 codes more than one-third are identical except for indicating laterality, or whether the right or left side of the body is affected. The advantage of ICD-10 codes is that they enable clinicians to capture laterality and other concepts in a standardized way that supports data exchange and interoperability for a more efficient health care system. While an ICD-9-CM code may identify a

2 condition of, for example, the ovary, the parallel ICD-10-CM code identifies four codes: unspecified ovary, right ovary, left ovary, or bilateral condition of the ovaries. What does an ICD-10 code look like? ICD-10 codes are alphanumeric and contain 3 to 7 characters. For example: K is the single ICD- 10 code for Crohn s disease of both small and large intestine with abscess reflecting a progression in the disease that justifies a repeat colonoscopy. What will the change require? It will affect databases and EHRs, billing systems, and other decision-making and analytical systems. The transition will require key upgrades and even the replacement of some current IT systems. Analyzing the impact of ICD-10 on a practice s business processes will be costly. As health plans modify their contracts to include the more specific codes, they may also alter their payment schedules, resulting in changes to a practice s cash flow. The shift to ICD-10 will also require software modifications in both the insurance coverage and billing sections of practice management systems. Billing service and clearinghouse vendors will also have to comply with the new system. The time and effort required to implement these changes could be significant. What s good about the transition to ICD-10? Migrating to ICD-10 will streamline health care reimbursement and quality. It will result in fewer coding mistakes in submitted medical claims, less need for supporting documentation and as a result, fewer requests for additional information after a claim has been submitted. This will reduce the number of claims rejected for lack of medical necessity, which is the number one reason why payers deny claims.

3 Computer science, combined with new, more detailed codes of ICD-10-CM, will allow for better analysis of disease patterns and treatment outcomes that can advance medical care. Other benefits include better sensitivity in refining grouping and reimbursement methods, and improvements to public health surveillance. Over time, physicians could see a substantial return on their ICD-10 investment. With more accurate payment for new procedures, physicians are projected to save $100 million to $1.2 billion within a decade of ICD-10 implementation. A reduced claims cycle will lower administrative costs for physicians. What s bad about the transition to ICD-10? The transition to ICD-10 is an example of how one cog in the revenue cycle can impact the entire wheel. It will impact every corner of the Revenue Cycle, from patient access to clinical care to IT/IS systems to billing and payment. Failure to transition smoothly may result in productivity reductions, rework and reimbursement denials. Who will it affect? In the context of the revenue cycle, ICD-9 to ICD-10 shows that reimbursement isn t solely the responsibility of the accounts receivable. ICD-10 impacts more than 50 populations, including physicians, healthcare executives, coders, case managers, nurses, and administrative staff. While health care organizations need to engage their payers to ensure a smooth transition, physicians and coders must be engaged in knowing how valuable their roles are in ensuring that bills get paid. How will it affect doctors? ICD-10 is about what happens in the clinical environment. It does not require a change in how physicians practice medicine or treat patients. Rather, it demands more accurate documentation and gives physicians more diagnostic choices to capture new data to ensure they are paid for the complex work they perform. Concepts that are new to ICD-10 are not new to clinicians, who are already documenting a patient's chart with more clinical information than an ICD-9 code can capture about: Initial Encounter, Subsequent Encounter, or Sequelae Acute or Chronic Right or Left Normal Healing, Delayed Healing, Nonunion, or Malunion The move to the ICD-10-CM will increase documentation activities about 15 percent to 20 percent. This translates into a permanent increase of 3 percent to 4 percent of physician time spent on documentation for ICD-10-CM. This is a permanent increase, not just an implementation or learning curve increase. It is a physician workload increase with no expected increase in payment, due to the increased requirements for providing specific information for coding. Electronic health record systems will not be able to eliminate the extra time requirement. Why should I prepare now for the ICD-10 transition?

4 The transition from ICD-9 to ICD-10 will change how you do business. Health care organizations, from large national plans to small provider offices, laboratories, medical testing centers, hospitals and more will need to devote staff time and financial resources for transition activities. What do we need to do, and when? Develop a plan for making the transition to ICD-10; include a timeline that identifies tasks to be completed and crucial milestones/relationships, task owners, resources needed, and estimated start and end dates. Start by reviewing how and where you currently use ICD-9 codes. Make sure you have accounted for the use of ICD-9 in authorizations/pre-certifications, physician orders, medical records, superbills/encounter forms, practice management and billing systems, and coding manuals. Experts recommend that individual physician practices focus on the majority of patients they see and start there. If you re an orthopedic surgeon, then focus on those changes. If you re a pediatrician and you see a lot of asthma, focus on that. Training to use the new ICD-10 code set may require up to 12 hours for providers. Costs may vary depending on the type of training materials used and the resources available. If your coders don t have a background in anatomy and physiology, they should take a course right away Buy an ICD-10 book and attempt to code the 50 most common codes in your practice Look at translation programs (icd9data.com and icd10data.com) and enter your most common diagnosis codes. From the results of your comparisons, make a list of clinical documentation improvements that will be required Select certain coders in your practice to go off-site for two-day training it s worth the time Develop a timeline for training clinical staff close to the implementation date Read the general guidelines for coding ICD-10. These are at the front of the book and on the CDC s website The transition to ICD-10 does not affect CPT coding for outpatient procedures and physician services. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only. CMS has implementation timelines and checklists for large practices, small and medium practices, small hospitals, and payers. Providers should 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. What happens if we don t use ICD-10 codes correctly after the Oct. 1 switchover? CMS and other payers will not be able to process claims, and hospitals and physicians will not get paid for services. Claims will need to be resubmitted with the ICD-10 codes. What is Hartford HealthCare doing to prepare for the Oct. 1 transition? We are currently in the midst of our General Awareness Campaign, which includes posters, digital signage, our website, newsletters and presentations to medical executive boards and staff meetings

5 throughout all of HHC. We have established plans for staff education leading up to the mandatory go-live date. Computer-based training will begin in March, with both general and specialty specific training modules. We will then offer classroom training. There will be presentations to divisions for further training. Throughout this period our Clinical Documentation Experts will help provide one-on-one education on the floors using individual charts as examples. Plans for training will evolve over time. Hartford HealthCare has also posted a SharePoint site with information and resources about ICD-10: Hartford HealthCare staff with questions about ICD-10 can Where can I find more information? ICD-10 resources are available through CMS, Medicare Administrative Contractors (MACs), professional associations and societies such as AHIMA and the American Academy of Professional Coders, and practice management system/ehr vendors. Visit regularly to access the latest information on training opportunities. Sign up for the CMS ICD-10 Updates to receive the latest news and resources on ICD-10.

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