By Therese M. Jorwic, MPH, RHIA CCS, CCS-P, FAHIMA
What in the world does the office do to get ready for it?
Here are the parts managers need to know about.
New book, same two volumes
ICD-10 is the revised version of ICD-9.
There are two parts to it, just as there are to ICD-9.
The first is the Clinical Modifications or ICD-10-CM (just like ICD-9-CM). Those are the diagnosis codes, and it’s the only part physician offices use.
The second part is procedure codes, but only hospitals use those. Offices use the CPT procedure codes instead. ICD-10 won’t affect the CPT codes at all. Offices will continue to use them just as they have been doing all along.
No, not really very difficult
It will take training, but ICD-10 coding shouldn’t be any more difficult than ICD-9 coding.
Yes, the codes look different. They can have up to seven letters and numbers whereas the ICD-9 codes can have no more than five numbers, and except for the E codes and V codes, they don’t use letters at all.
And yes, there are more ICD-10-CMs than ICD-9s. But not a tremendous amount more. And as is the case now, offices will only use the ones that apply to their practice areas, so don’t expect to be deluged with a ton of new codes.
Clearer codes, similar guidelines
In general, the changes that I-10 brings are good clarifications. They make it possible to tell more about the patient’s diagnosis, often with fewer codes.
An example is diabetic retinopathy.
With ICD-9, there are two codes. The first is for diabetes with ophthalmic manifestations – 250.5x, with the fifth digit showing the type of diabetes and whether it is uncontrolled. The second is for the diabetic retinopathy.
With ICD-10, however, it’s possible to cover the diabetes, the type of retinopathy, and even macular edema with just one code. If the diabetes is Type 1 with macular edema, for example, the code is E10.341. The 3 says ophthalmic complication, the 4 says severe nonproliferative retinopathy, and the 1 says macular edema.
The guidelines for using the ICD-10 codes are much the same as those for ICD-9.
For HIV, for example, the ICD-9-CM guidelines say that if the patient has HIV with manifestation, code the HIV first. And the ICD-10-CM guidelines say the same.
Thus, the office will be following almost the same guidelines. It will just be using different codes.
As to format, the new codes have up to seven characters and all of them have both letters and numbers. By contrast, the ICD-9-CM codes never have more than five characters, which are most of the time numbers.
A longer but not too long superbill
The superbill will, of course, be longer with ICD-10-CM, simply because there are more specific codes for many diagnoses.
For example, with cortical senile cataracts, ICD-9-CM has just one code (366.15). But with ICD-10-CM, the superbill will have to include codes for left eye, right eye, bilateral, or unspecified.
However, the office should be able to redesign its superbill inhouse. Any staffer who has completed ICD-10 training should be able to do it.
On the AHIMA website are two good examples of how an updates superbill might look. Go to http://www/ahima.org/ICD10/faqs.aspx. The links to the examples are on the far left side.
Where to find the training
Moving to the new codes will, of course, require training, and for that, there are a myriad of sources. Google “ICD-10 training” and all sorts of options appear, from seminars to online programs sponsored by both professional organizations and commercial vendors.
Of particular interest is the training being provided by the American Health Information Management Association. AHIMA has set up an academy for “trainer training” or education for people who will become ICD-10 trainers. A trainer gets AHIMA approval by completing a training course plus some preliminary work and passing an assessment. The trainers also take continuing education.
Many of the trainers are called ambassadors, which means they are available to provide training for offices and other groups and have posted their contact information on the AHIMA site.
To reach an ambassador, go to https://secure.ahima.org/Certification/Ambassador/Search.aspx and in the search boxes click on “ambassador” and indicate the state. Below that click on the setting (“physician practice”), and the search will give the names and e-mail addresses of the people who fit that description.
Some trainers have chosen not to post contact information, but the office can check that same site to see if an individual has AHIMA approval.
As to how long the training will take, the answer is not very long at all.
The government estimates that learning the diagnosis codes alone – not the procedure codes that hospitals use – will take only about 16 hours of training, and that includes preparation and practice.
Even the AHIMA academy training currently lasts just two days. It covers the individual chapters of the ICD-10 book plus coding for the individual setting where the training will work – physician office, home health agency, nursing facility, or whatever.
Everybody needs a little training
The amount of training depends on the office.
In a small office where the manager does hands-on work, the manager will probably need the same training as the coder. In a large practice, only the coding and billing staff will need full training.
But everybody – staff and physicians – needs at least basic training in ICD-10 to understand what’s going on – the background, why the new codes are needed, and how the new codes differ from ICD-9.
Everybody should also know which codes the office will be using and how to follow the new superbill.
As to who should do the training, that’s the office’s choice. A small office might decide to send everybody in the billing department to a training course. A large practice might name a lead person to get training and then train the rest of the staff. Or the office might get an outsider to do the training inhouse.
The physician documentation
Perhaps the most difficult part of ICD-10 is that the physician documentation will have to be as specific as the codes are. Thus, the doctors will need to learn what documentation is needed for each of the codes on the new superbill.
The positive side of that, however, is that much of the documentation is already there.
For example, in obstetrics, many of the ICD-10-CM codes include the trimester. ICD-9-CM doesn’t show the trimester, so coders don’t look for it, and many doctors don’t document it. But just about all doctors routinely document it. But just about all doctors routinely document the number of weeks in the pregnancy, which indentifies the trimester.
Another example is laterality. The ICD-10 codes include it whereas ICD-9 doesn’t. But for any condition that can affect the right, left, or both sides, doctors are already documenting which eye or ear or limb or whatever is affected. Coders just haven’t been looking for that information.
Urban legends and code books
Some time ago, urban legend said ICD-10 had so many codes that there would not be a printed version of it – only online access.
But the books are indeed here, and they aren’t much larger than the ICD-9-CM books. Medical offices only need the ICD-10-CM codes, which are included in one book. It’s the same size as the current book and about two inches thick with a little over 1,000 pages. And the print is standard size.
The books are available from the same companies that publish the ICD-9-CM books.
Therese M. Jorwic, MPH, RHIA, CCS, CCS-P, FAHIMA, is assistant professor of health information management at the University of Illinois at Chicago and senior consultant for MC Strategies in Atlanta.
She is also coauthor of ICD-10-PCS: An Applied Approach, a book on hospital inpatient coding published by AHIMA Press.
