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Frequently Asked Questions about ICD-10 – CM and PCS

The implementation of ICD-10 is looming and according to the Center for Medicare and Medicaid Services (CMS), there will be no extension to the October 1, 2015 deadline. This means that with almost a month left, healthcare practitioners must have all the facts about the ICD-10 conversion at their fingertips. Here we have prepared a handy tip-sheet of frequently asked questions for you to be even more informed about the transition.

What is ICD-10?

Let’s start at the very beginning. ICD-10 stands for the International Classification of Diseases, a global initiative by the World Health Organization (WHO) to organize and index all diseases and conditions in a way that is easy to analyze and create prevalence models. The precursor to ICD-10, ICD-9, was adopted in 1979 and has served as a foundation for the development of the health sector in the US.

How does ICD-10 affect health practitioners?

It’s mandatory for every provider falling under HIPAA (Health Insurance Portability and Accountability Act) to make the transition from ICD-9 to ICD-10. This covers both diagnosis and inpatient procedure coding so it affects any reporting a health practitioner does in accordance with HIPAA.

What was wrong with ICD-9 for it to be replaced?

The short answer is nothing. The long answer is that ICD-9 was developed and adopted by the International Conference for the Ninth Revision of the International Classification of Diseases, convened by WHO, in 1978 and has had to keep up with the tremendous changes and advances in medicine. Instead of continually revising ICD-9, it became necessary to transition to a new version capable of serving the medical community globally for at least the next 25 years.

What’s the difference between ICD-9 and ICD-10?

There are both subtle and obvious differences. The most important one is in the breadth of coverage that ICD-10 can now handle. Whereas ICD-9-CM could only identify and code approximately 13,000 data points, ICD-10-CM significantly expands on this with 68,000 codes and the ability to record new procedures and diagnoses. Other differences include the coding structure with ICD-9 having 3-5 characters while ICD-10 has 3-7 characters. However, the method of reporting remains the same with the types of classifications and code structure found in ICD-9.

I’ve read about ICD-10-CM and ICD-10-PCS. What’s the difference?

ICD-10-CM, or “ICD-10 Clinical Modification,” is the modified version of ICD-10 used for claims submissions and billing in the United States. ICD-10-PCS, or “ICD-10 Procedure Classification System,” is a set of coding standards developed by the Center for Medicare and Medicaid Services (CMS) and is primarily used for resource allocation rather than aspects related to medical procedures. Therefore, as a practitioner, you will be using ICD-10-CM.

Is there any chance the deadline could be extended?

Not currently. The main thrust of transitioning to ICD-10 is to ensure that reporting and the quality of data collected keeps pace with the advancements in healthcare. As long as the old ICD-9 is being used, there’s degradation in the quality of information being collected in relation to the new forms of data and data analysis available.

You said ICD-10 has 68,000 codes! How will we report on so many?

You won’t have to. Think about it this way: When you are having a conversation, you don’t need to use all the words available in the English dictionary, only the ones relevant to the conversation. In the same way, when it comes to reporting on ICD-10 codes, you’ll only need to report on the codes related to your specialty.

What about cost?

Cost is a legitimate issue that has been raised with the CMS time and again. There will be direct and indirect costs associated with the transition, so it’s best to budget for both. The direct costs will involve training staff, upgrading software and systems (or replacing them altogether), and hiring new staff to help with the transition. Indirect costs will be associated with employee downtime as they learn the new reporting standards, drops in revenue from payers as both parties attempt to synchronize their data, and other yet unknown costs that may crop up along the way.

What benefits will ICD-10 bring my practice?

There are several benefits ICD-10 adoption will bring to practices and the general healthcare system in the US. The number one will be increased quality of data collected, as it will be easier for practices to measure their effectiveness in providing superior healthcare. The greater coding accuracy will also lead to fewer claims denials. You will also need less documentation to support claims, as the information collected will lead to easier health record reviews and faster reimbursement adjudication. 


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