ICD-10-CM: Out With the Old, In With the New

The following article is written by Rosalind Richmond, chief coding and compliance officer for GENASCIS.

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It gets hard to say "Out with the old" when it means saying goodbye to a coding classification system that we have relied on since the early 70s. The result is a new way to think, collect and reflect on coded medical data. The question is, "Are you ready for change?" "In with the new", ICD-10-CM is a unique coding system that will provide relevant information for ambulatory and managed care encounters. This new system allows for further expansion than was allowed in ICD-9-CM.

With five times as many codes, the ICD‐10-CM transition will require significant changes to existing practices. The increased granularity of the ICD‐10-CM codes would also require additional documentation from providers to support the patient's diagnoses.

The compliance date for implementation of ICD-10-CM is Oct. 1, 2013. Most organizations are in the pre-contemplation phase for implementation. Some are thinking about the upcoming date, but not really making an effort to start planning for implementation. Do we know what is involved in the process of changing our classification system?

First we need to take a look at the sections in the new classification system (ICD-10-CM). There should be a focus on internal coding and documentation issues that will pose a significant challenge for data integrity and reimbursement.

Below is a sample cross map of ICD-9-CM to ICD-10-CM:

The ICD‐10‐CM codes are alphanumeric, as opposed to the primarily numeric ICD‐9‐CM codes. It contains up to seven characters, as opposed to the five characters in ICD‐9‐CM. The ICD-10-CM codes S53.031–S53.033 require seven characters and are further expanded with the requirement of a seventh digit. In order to accomplish this, an "X" is used as a placeholder and the seventh digit is assigned.

The above section requires an additional digit from this selection:

EXAMPLE: S53.031xA – Nursemaid's elbow, right elbow, initial encounter

In the above example, physicians treating injuries will benefit from learning to document initial, subsequent, or sequela type patient encounter.

Prior to the implementation of ICD-10-CM, a review of current documentation will determine if documentation improvement from the physicians is necessary.

Many organizations have actually moved from pre-contemplating the upcoming code-set change to actual contemplation, and are thinking about the impact of the change. Coders and physicians will benefit from general information early, and more information based on their individual roles. The effective date for ICD-10 may be in the distant future, but everyone should be taking steps to make the transition.

More information regarding ICD-10-CM can be found at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm.

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The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.