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ICD-10-CM Myths and Facts

The ICD-10-CM/PCS implementation deadline for everyone covered by HIPAA is set for October 1, 2015 and it is expected that all HIPAA-covered entities will have completed the transition from ICD-9-CM to ICD-10-CM/PCS by this date. The release of the ICD-10-CM/PCS has led to the rise of several myths to be addressed regarding the transition and supposed increased complexity.

The ICD-10-CM/PCS is outdated

Despite the fact that the ICD-10-CM/PCS was first released in 1994, it is untrue that the ICD-10-CM/PCS is outdated. The ICD-10-CM/PCS has been kept up to date with the array of changes in healthcare, which is necessary given the huge advances in technology and medicine since it was first released. This constant development has come in the form of annual code updates, although these were partially frozen from 2011 onwards to allow for easier implementation. From October, 1 2015, updates to ICD-9-CM will stop and from October 1, 2016, regular annual updates to the ICD-10-CM/PCS will resume.

The transition deadline is flexible

Another of the many misunderstandings regarding the ICD-10-CM/PCS is that HIPAA-covered entities will be granted an extension by HHS beyond the deadline date of October 1, 2015. This is not a correct assumption to make; HHS has confirmed it has no plans to extend the deadline. All HIPAA-covered entities must complete the stages of their ICD-10-CM/PCS implementation plan by the deadline.

Non HIPPA-covered entities don’t need to adopt ICD-10-CM/PCS

There is also no basis to assume that non-covered entities should choose not to use the ICD-10-CM/PCS system.  The HHS has recommended that it is in the best interests for all non-covered entities to transition to the ICD-10-CM/PCS. The CMS will work to encourage non-covered entities to switch to the ICD-10-CM/PCS.

ICD-10-CM/PCS was developed without clinical input

HHS has made it clear that ICD-10-CM/PCS was developed with the aid of significant clinical input, coming from a set of medical specialty societies, refuting the myth that it was created without the input of those who will be using it.

ICD-10-CM/PCS has excessively complex codes

Another key myth to address is the idea that ICD-10-CM/PCS’s increased number of codes makes it much more complicated than its predecessor, ICD-9-CM. On the contrary, the new system is easier, quicker and more clinically accurate. The greater number of codes enables a more specific level of code selection, and this is also improved by the more sophisticated logical structure. ICD-10-CM/PCS also has manageable code books available, and these code books are not reliant on electronics.

A negative impact on medical record documentation

Some medical professionals fear that ICD-10-CM/PCS will create the need for over-complicated medical record documentation. An AHIMA study showed that ICD-10-CM/PCS often contains detail already present in medical record documentation, effectively disproving this myth. In contrast, ICD-9-CM codes did contain the same detail.

ICD-10-CM/PCS will lead to unnecessary diagnostic tests

ICD-10-CM/PCS codes are derived from medical record documentation. As such, if you are unable to come to a satisfactory diagnosis, the condition can be coded to its highest degree of certainty. As this highest degree of certainty may just be the identification of certain symptoms, ICD-10-CM/PCS is superior as it has an increased number of codes for signs and symptoms, and so improves on the ICD-9-CM by being more effective for non-definitive diagnoses. ICD-10-CM/PCS also maintains the availability of nonspecific codes.

ICD-10-CM/PCS super bills will be so long that they become useless

ICD-10-CM/PCS super bills may not be longer than ICD-9-CM super bills as healthcare practices are encouraged to undertake the super bill conversion process. This involves removing rarely used codes and using GEMs or the code book to crosswalk common codes. ICD-10-CM/PCS still enables the creation of super bills with only the most common Diagnosis Codes for each individual practice.

GEMs are to help with coding and are restricted to Medicare

GEMs were designed as a temporary mechanism to aid conversion from ICD-9-CM to ICD-10-CM/PCS and vice versa. The GEMs were developed and placed in the public domain by CMS and CDC for all healthcare providers to use, free of charge. They can be used for payment systems, risk adjustment logic, quality measures and for research applications. They are not designed for use as help for coding medical records; help regarding coding is provided in the code books. HHS has drawn a clear distinction between mapping and coding. Mapping is the linking of concepts between two code sets, regardless of the medical record information. Coding is assigning the most appropriate code based on guidelines and medical record documentation.

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