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ICD-10 Is Here: Are You Ready?

On Thursday, October 1, the United States transitioned from using ICD-9 to using ICD-10 as the medical code set for medical diagnoses and inpatient hospital procedures. This transition is occurring because the International Classification of Diseases (ICD), used to standardize codes for medical conditions, diagnoses and institutional procedures, has not been updated in the U.S. for 35 years. The current code set, ICD-9, contains outdated and obsolete terms that are inconsistent with current medical practice.

“The rest of the world has been using ICD-10 for a long time now,” said David Johnson, vice president, revenue cycle. “ICD-10 was initially supposed to be implemented in 2012," he shared, but the go-live date was moved to October 1, with no further extensions coming.

ICD codes
ICD is the most widely used statistical classification system for diseases in the world. ICD codes are used for recording illness diagnoses, symptoms, treatment and medications. These codes are universally accepted, even internationally, which helps in handling epidemics and in creating efficient broad-scale systems. For hospital providers, payment is delivered by diagnostic codes. The ICD-10-CM, or diagnosis codes, will be used by providers in every healthcare setting. ICD-10-PCS, or procedure codes, will be used only for hospital claims for inpatient hospital procedures. Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes will continue to be used for outpatient, ambulatory and office-based procedure coding.

Documentation is an important component of ICD-10
Providers are now required to document the nature of patient conditions and services done to maintain or improve those conditions in specific detail. The documentation requirement supports proper payment of claims and reduces denials, assures accurate measures of quality and efficiency, increases accountability and transparency, enhances communication with hospitals and other providers and tells the patient’s full clinical story. “Basically,” noted Johnson, “if it is not documented, it didn’t happen.” The primary focus of documentation is good patient care, and patients deserve to have accurate and complete documentation of their conditions.

Physicians need to prepare for ICD-10 implementation
If providers do not use a valid ICD-10 code beginning October 1, they will not be able to bill for their services. To help providers get ready for the deadline, Summa Health will offer ongoing education through HealthStream. Providers will be notified via email when these classes are available, and it is extremely important that they complete their education.

In addition, the Centers for Medicare and Medicaid Services recently announced a 12-month grace period to allow for additional flexibility in the claims auditing and quality reporting process to help providers successfully transition. While a valid ICD-10 code will still be required on all claims beginning October 1, this means that Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a code from the right family.

“I would still advise physicians to act as if there is no grace period in place,” said Johnson. “Learn the codes, complete the documentation and you will be in great shape for the future.”

Summa Health is prepared
“Summa Health is ready for the ICD-10 deadline,” said Diane Kramanak, administrative director, health information management. “We have created a comprehensive implementation roadmap along with project plans identifying the impact and gaps. We are currently preparing and deploying our education plans, as well as designing processes to better support the transition. We have also done extensive testing and developed remediation strategies.”

Additional resources for the ICD-10 transition
Utilize these additional resources to help with the transition to ICD-10:

  • Visit the Centers for Medicare and Medicaid Services website for more information about ICD-10.
  • Read the ICD-10 Quick Start Guide which outlines the five steps healthcare professionals should take to prepare for ICD-10.
  • Visit the “Road to 10,” which is specifically geared toward addressing the needs of small physician practices, but is helpful for other providers as well.

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