Yes, it’s true. Just one short year away and it will be here. Don’t say that you haven’t been warned because there’s been plenty of time to get prepared.
But, here’s a secret—with just a little work and preparation, you and your practice can be ready to incorporate the new coding system smoothly into your day-to-day routine. Here’s how to get started.
Know the Code
We all know that ICD-10 is much more specific, but let’s break it down so you can understand the new format. The ICD-10 adopts a new configuration that is a complete departure from the familiar ICD-9. Currently, with the ICD-9 diagnosis codes, each code has three to five digits, with most having five because we’re obliged to always code to the highest level of specificity.
The ICD-10 is a completely different system and has different conventions and foundational rules that we’ll have to learn and get comfortable with. The basic structural composition of an ICD-10 code has three to seven digits/characters (alphabetic ones are not case sensitive):
• Digit one is alpha (i.e., A to Z)• Digit two is numeric
• Digit three is alpha or numeric and is followed by a period
• Digits four to seven are alpha or numeric
The table below gives two examples:
| ICD-9 vs. ICD-10: Optometric Examples
| 367.1 Myopia
||H52.11 Myopia, right eye
H52.12 Myopia, left eye
H52.13 Myopia, bilateral
H52.10 Myopia, unspecified eye
| 365.11 Primary open angle glaucoma
||H40.11X0 POAG. stage unspecified
H40.11X1 POAG, mild stage
H40.11X2 POAG, moderate stage
H40.11X3 POAG, severe stage
H40.11X4, POAG, indeterminate stage
Another one of the key issues sure to surface will be having to maintain both systems in practice for at least a year during this transition. A brand new CMS-1500 form has been published ( www.nucc.org/images/stories/PDF/1500_claim_form_2012_02.pdf) and will be in effect starting January 1, 2014. It will allow up to 12 ICD-10 codes in the diagnosis section vs. the four ICD-9s that can currently be listed.
Keep in mind that health care claims can generally be filed with a third-party insurer up to one year after the date of service. Theoretically, all patients for whom you provide care between October 1, 2013 and September 30, 2014 could be filed or re-filed up to September 30, 2014—but you’d have to use the ICD-9 diagnostic codes for these claims because the ICD-10 won’t be in force yet. (So, if the resubmission date occurs after ICD-10 goes into effect, you’ll need to resubmit the older claim with the then-current ICD-9 code that was appropriate at the time of service.)
Take Action Now
Although the new ICD-10 code sets won’t be here for another year, there’s several things you can do right now. You should become familiar with the timeframe of implementation, set goals and target dates of education, work with your software manufacturers to find out how they’re in incorporating the ICD-10 into their products and, most importantly, stay up-to-date by learning where the resources for the ICD-10 can be found.
Stay tuned—Coding Abstract will help smooth out the bumpy road ahead.
Get More Info on ICD-10
Want to learn more? The Centers for Medicare and Medicaid Services' website has all sorts of information about the ICD-10: www.cms.gov /ICD10.