Coding Strategy

Plus: CMS has proposed freezing the ICD-9 codeset after next year.

If you were hoping that the Oct. 1, 2013 ICD-10 implementation date wasn’t set in stone, you are out of luck. That’s the word from CMS during a June 15 CMS Open Door Forum entitled “ICD-10 Implementation in a 5010 Environment.”

“There will be no delays on this implementation period, and no grace period,” said Pat Brooks, RHIA, with CMS’s Hospital and Ambulatory Policy Group, during the call. “A number of you have contacted us about rumors you’ve heard about postponement of that date or changes to that date, but I can assure you that that is a firm implementation date,” she stressed.

Brooks indicated that the rumor about a potential delay in the implementation date continues to persist throughout the physician community, and recommended that practice managers alert their physicians to the fact that that the rumor is untrue.

The Oct. 1, 2013 date will be in effect for both inpatient and outpatient services. Keep in mind that the ICD-10 implementation will have no impact on CPT and HCPCS coding, Brooks said. You will still continue to bill your CPT and HCPCS procedure codes as before.

You’ll Find Nearly 55,000 Additional Codes

Currently, CMS publishes about 14,000 ICD-9 codes, but there are over 69,000 ICD-10 codes. The additional codes will allow you to provide greater detail in describing diagnoses and procedures, Brooks said.

If you’re wondering which specific codes ICD-10 includes for your specialty, you can check out the entire 2010 ICD-10 codeset, which CMS has posted on its Web site. “Later this year, we’ll be posting the 2011 update,” Brooks said during the call.

@ For more details on CMS’ upcoming plans, subscribe to Part B Insider (Editor: Torrey Kim, CPC).

Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.

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Wrap your brain around using letters in your diagnosis codes.

If you aren’t curious about how the ICD-9 codes crosswalk to ICD-10, maybe you should be.

“The transition date for ICD-10 codes is Oct 1, 2013,” stressed CMS’s Stewart Streimer during a CMS-sponsored Open Door Forum. “That’s really the drop-dead date for those of you that have familiarized yourselves with the Final Rule regarding ICD-10 … but there are a lot of things that must happen before then, and I expect many of the payers may even require ICD-10 codes before then so a sufficient amount of testing can take place,” he said.

Choosing Vendors? Speak Up

Today isn’t too soon to start thinking about ICD-10, says Helen Avery, CPC-I, CHC, senior coding and revenue cycle consultant at Los Angeles-based Sinaiko Healthcare Consulting Inc. The more familiar you are with the changes, the easier the transition will be. “Obtain education and understanding early on so that you will be well equipped. Start by speaking with your physicians now about improving their clinical documentation detail which will be the most important aspect for them and should be started prior to the change,” Avery says.

Coders also should be involved when practices communicate with “information system vendors (for EMR, claims processing, etc.) about their plans for the new code set implementation,” advises Avery.

Check out these examples of current ICD-9 versus future ICD-10 codes.

Starting point: This rundown based on the ICD-10 2010 files posted at www.cms.hhs.gov/ICD10/02k_2010_ICD_10_CM.asp will help give you an idea of what to expect. You can also find the 2010 ICD-10 index and tabular list at www.cdc.gov/nchs/icd/icd10cm.htm#10update. But remember, your final ICD-10 code choice will depend on the codes and guidelines in effect at that time, as well as the physician’s specific documentation.

Want to be ahead of the game? Attend the ICD-10 Issues: Get Ready for the Conversion ASAPaudio conference.

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Bonus: Get exposure to ICD-10 coding equivalents.

Question: A mentally-challenged patient who delivered at home was admitted to the hospital for postpartum care. The patient delivered the placenta at home, and once admitted, she had no complications, but the ob-gyn did perform a first degree laceration repair. I’m not sure what diagnosis code to report. Should I look at routine postpartum care or pregnancy complications? And if I use a complication code, what would the fifth digit to a “1″ or “0?”

Texas Subscriber

Answer: Under most situations where the ob-gyn treated no problems during the admission, you would code V24.0 (Postpartum care and examination; immediately after delivery) on the admission date and V24.2 (Routine postpartum follow-up) for any subsequent routine care.

But in this case, your physician also repaired a first degree laceration (CPT code 59300, Episiotomy or vaginal repair, by other than attending physician). Therefore, you may consider this to be an admission for a postpartum condition and instead report 664.04 (First degree perineal laceration). The fifth digit cannot be “1″ or “0″ because the patient delivered prior to her admission and of course you know her delivery status. In this case, the fifth digit must be “4″ to indicate a purely postpartum condition. You may optionally report V24.0 and V24.2 as your secondary diagnoses, but they are not required in this case.

ICD-10: In the near future, you will replace ICD-9 codes V24.0 and V24.2 with ICD-10 codes Z39.0 (Encounter for care and examination of mother immediately after delivery) and Z39.2 (Encounter for routine postpartum follow-up), respectively. Code 664.04 will be replaced by O70.0 (First degree perineal laceration during delivery).

@ Ob-gyn Coding Alert

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We’ve got the link to a nifty ICD-9 to ICD-10 code translator.

Maybe I’m getting old, but I just can’t believe we’re about to ring in the second decade of the 21st century. It seems like just yesterday I was toasting the new millennium and breathing a sigh of relief that “Y2K” wasn’t the big catastrophe we all dreaded.

With time whizzing by so fast, now’s the time to prepare for ICD-10 implementation. And some coders dread ICD-10 as much as anyone ever dreaded Y2K. The number of our diagnosis codes will swell from 13,500 to 120,000, for example. And if we’re certified coders, we’ll have to demonstrate our ICD-10 expertise in order to maintain our certifications. I know I’m too old for another test!

If you feel like you’re already behind on ICD-10, here are 3 links to help you learn more.

For some free webinars that teach you ICD-10 basics and help you plan for implementation, go here. The AAPC’s Deborah Grider gives you some quick tutorials and some helpful slides.

Tip: If you’re a coder who works for a payer, the AAPC has a handy free webinar track designed especially for you.

I really like this handy ICD-9 to ICD-10 code translator tool available on the AAPC web site. The folks at AAPC have developed the tool from CMS files, and I’ve enjoyed playing around on it to get an idea of how my diagnosis coding will change with ICD-10.

Finally, the complete set of ICD-10 codes is available here from CMS. I’ve not read it cover to cover. Perhaps I’ll save it for beach reading this summer.

Want easy, quick ways to learn more about ICD-10? Stay tuned to Coding News. Will teach you as we learn ourselves.

Here’s one more reason to celebrate 2010: Your FREE trial to Supercoder. Get details here.

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