Getting Set for ICD-10

Oct.1, 2015 marks the official compliance date for implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10) by Centers for Medicare and Medicaid Services (CMS), the first update to the standardized codes for medical conditions and procedures in more than 35 years. 

The newly expanded codes – jumping from 14,000 to 69,000 – will grant healthcare professionals greater specificity and clinical accuracy for noting procedures and diagnoses, but could also present obstacles and headaches in the transition from the previous ICD-9 codes.

What’s Changed With ICD-10?

After delaying the implementation deadline several times, the new ICD-10 code expands the number of codes for procedures and diagnoses. Some of the most significant changes are noted below:

Source: CMS.gov

Medicare claims processing systems will not accept ICD-9 codes for dates of services after today, Sept. 30, 2015 and will not accept claims that include both ICD-9 and ICD-10 codes. However, CMS and the American Medical Association (AMA) agreed to a one-year grace period in which Medicare claims will not be denied based on which diagnosis code was selected, as long as an ICD-10 code from an appropriate family of codes is submitted; the family of codes is considered the same as the ICD-10 three-character category. For example, if a patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus) under ICD-10, use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) would likely not prompt an audit during the 12-month grace period.

Steps to Take to Get Prepared

As the deadline approaches, some clinicians may be scrambling to transition based on their practice and patient population. In a recently-published article on the AMA Wire, officials with the the AMA recommend the following advice for healthcare professionals who have not yet taken action:

1. “Call all vendors immediately: ask about any updates needed immediately and how to address issues after October 1.
2. Get staff trained quickly: CMS and the AMA offer a variety of resources, some of which are specialty-specific.
3. Focus on your top 10-15 diagnosis codes: Rhonda Buckholtz, vice president of ICD-10 education and training for the American Academy of Professional Coders, recommends creating a practice management report to determining the top diagnoses with ICD-10.
4. Acknowledgement reports: watch acknowledgement reports closely after claims are submitted to spot issues immediately.
5. Establish cash reserves: if possible, have cash reserves on hand or look into lines of credit should payment get interrupted and you need them.”

This article originally appeared on MPR