ICD-10: CMS Lays Down the Facts In Recent Provider Call-In


For those of you who are like me, whose heads are spinning from all the other changes going on in physician practice management, one of the most challenging adaptations we will go through is now hovering on the horizon, and I’ve chosen to ignore it long enough.  I’m talking about the conversion from ICD-9 diagnosis coding to ICD-10.

My office staff and I have just sat in on the CMS National Provider Call entitled Implementation Strategies for Physicians.  This is one in a series of many presentations CMS will host as we approach the October 2013 implementation date.  A copy of the presentation slides is available at http://www.cms.gov/ICD10/Tel10/list.asp.

I found it very informative covering the origin of diagnosis reporting leading up to where we are now.  They were very clear that this has been a project in the works since 1993, and the notion that this coding convention is being rushed into haphazardly was quickly crushed by the facts.  They went on to say that this initiative was not driven by governmental or private payers, but by the specialty societies requesting the ability to describe disease processes more specifically.  The change will not be postponed, it is inevitable.

It should also be mentioned that we need to make this move for some very simple reasons.  First of all, we have quite frankly run out of space for adding new conditions and codes in ICD-9, and some of the items are obsolete.  It has been a system that has served us well for 30 years, but now it’s time to move on to a system that will allow us to build on ICD-9 and allow us to provide additional detail for morbidity and episodes of care.  ICD-10 will move us from what was predominantly a numeric coding system to an alpha-numeric system.  We will go from 16,000 codes to approximately 70,000 codes.

Preparing for ICD-10

Whether you know it or not, you are already preparing for ICD-10 because of the upcoming 5010 format conversion for electronic transactions.  This formatting change is necessary to lay the foundation for reporting ICD-10 codes.  Therefore, by the beginning of 2012, you should be moving in the right direction.  It is suggested that you start assessing the needs of your office to determine a conversion plan.  This will entail billing system software upgrades, staff training, and encounter form updates.  ICD-10 books are available now.  Physicians and staff who spend a little time getting familiar with ICD-10 and its index will be ahead of the curve when 2013 rolls around.  In addition, CMS has created a General Equivalency Mapping tool that will help you understand how to map the ICD-9 codes that you most often use to the appropriate ICD-10 code.

This is a huge change for the industry overall, but with a little planning, we have enough time to ensure a smooth transition.