The new winner of my ongoing competition for the CMS Employee Speaker contest is Dr. Daniel Duvall, Medical Officer, Hospital and Ambulatory Policy Group Center for Medicare! During a recent ICD-10 call, Dr. Duvall spoke clearly, was easy to understand and kept my attention.
Why are we moving to ICD-10?
ICD-9 has deficiencies, such as:
- Not enough detail for analyzing diseases
- Not enough detail for payment
- Insufficient attention to:
- Medical encounters for reasons other than death
- Non-lethal manifestations
- Out of room for new codes
- Obsolete family groups
- Unable to address 30 years of medical knowledge of etiology
- Inadequate attention to continuum of disease and clinically relevant subsets
ICD-10 brings to the table:
- Appropriate payment via stratification of morbidity (“My patients are sicker”)
- Specificity needed for episodes of care, Affordable Care Organizations, Hierarchical
Condition Categories, and quality monitoring
- Better quality in research/clinical trials
- Identification of consistent cohorts
- Improved outcomes from population analysis
- Targeting resources to diseases: specialty, county, environment
- 2010 computational power cannot use 1980’s information
The detail is demanded not by government nor by payers but by specialty societies.
What exactly is ICD-10?
- Stands for International Classification of Diseases
- Developed by World Health Organization (WHO)
- The order of chapters is just like ICD-9
- Was originally released in 1993 and adopted by other countries
- Approximately 2000 diseases (families)
- Approximately 70,000 specific codes
- ICD-10-CM (diagnoses) will be used by all providers in every health care setting
- ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures
- ICD-10-PCS will not be used on physician claims, even those for inpatient visits (procedure coding system)
Will ICD-10 change the use of CPT and HCPCS?
There will be no impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes – CPT and HCPCS will continue to be used for physician and ambulatory services including physician visits to inpatient.
How much of a headache will ICD-10 really be?
Dr. Duvall characterized how difficult the transition to ICD-10 will be for each stakeholder group, by assigning them stars and headache types. The more stars, the more head-pounding the transition will be!
- Government, CMS & CDC will have 5-star headaches (encephalitis)
- Health Insurance Plans will have four-star headaches (migraine)
- Hospitals will have three-star headaches (cluster)
- Billing Agencies will have two-star headaches (sinus)
- Physicians will have one-star headaches (tension)
What should practices be doing now to prepare?
- Create a new job aid (cheat sheet) or superbill
- Update proprietary software or contact billing software vendor to discuss changes
- Train your coders and billers
- Train your physicians and providers
- Purchase new coding books and forms
- Develop a conversion plan –
- Paper Charts
- For some small conversion projects it may well be quicker and more accurate to use ICD-10 code books instead of GEMs (crosswalks)
When will the change to ICD-10 happen?
- Single implementation date of October 1, 2013 for all users
- Ambulatory and physician services provided on or after 10-1-2013 will use ICD-10-CM diagnosis codes
- Inpatient discharges occurring on or after 10-1-2013 will use ICD-10-CM and ICD-10-PCS code
- ICD-9-CM codes will not be accepted for services provided on or after October 1, 2013
- ICD-10 codes will not be accepted for services prior to October 1, 2013
- Last regular, annual updates to both ICD-9-CM and ICD-10 will be made on October 1, 2011
- On October 1, 2012 there will be only limited code updates to both ICD-9-CM & ICD-10 code sets to
capture new technology and new diseases
- On October 1, 2013 there will be only limited code updates to ICD-10 code sets to capture new
technology and new diseases
- There will be no updates to ICD-9-CM on October 1, 2013 as the system will no longer be a HIPAA
- On October 1, 2014 regular updates to ICD-10 will begin
Q & A (my favorite!)
Q: What will the financial impact be for a small practice to implement ICD-10?
A: This is dependent on how claims are being submitted and if the practice is responsible for paying for the system upgrade to handle ICD-10. If you are using free electronic billing, there should be minimal financial impact.
Q: Is the cost to the American public worth the value ICD-10 is supposed to create? Also, will offices be required to “prove” the new codes by sending medical records to payers?
A: Dr. Duvall answers “Yes” to the first question. As to the next question, that process is related to new codes moving from experimental to actual, not the process of moving from ICD-9 to ICD-10. Payers will not be requesting mass medical records since the change is global.
Q: With 2 years to go, when should we start training the staff?
A: You should start training 6-9 months before October 2013.
Q: There will be a tremendous impact on practices where physicians have not been documenting appropriately as there will not be enough information to choose a code. You are minimizing the physician’s time and effort needed to make this change.
A: Anyone who has been documenting correctly will have a relatively easy time choosing an ICD-10 code. Anyone who has been documenting minimally will have a hard time.
Q: What format will the new codes be released in?
A: They are in pdfs now, and they are also available in text and html formats.
Q: What will commercial payers be using for ICD-10?
A: Payers might be using GEMS (General Equivalence Mappings) to map from ICD-10 to ICD-9 if they are not ready.
General Equivalence Mappings (GEMs) assist in converting data from ICD-9-CM to ICD-10
Forward and backward mappings – Information on GEMs and their use – (click on ICD-10-CM or ICD-10- PCS to find most recent GEMs)
The CMS Sponsored ICD-10 Teleconferences web page provides information on upcoming and previous CMS ICD-10 National Provider Calls, including registration, presentation materials, podcasts, video slideshow presentations, written transcripts, and audio recordings http://www.cms.gov/ICD10/Tel10/list.asp
Provider Resources (for all providers) http://www.cms.gov/ICD10/05a_ProviderResources.asp