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Published 4/1/2013
Margaret A. Skurka, MS, RHIA, CCS, FAHIMA

ICD-10-CM: It Is NOT All That Bad

Taking steps now will help ensure a smooth transition

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)—You’ve heard of it and, so far, what you’ve heard has you scared. Thousands of new codes, some of them sounding absolutely absurd.

But believe me, ICD-10-CM is not the beast that some writers and publications make it out to be. It is manageable, and you can rest assured that you will NEVER use all those codes. Just as now, you will find the ones that are most applicable to your practice and focus on those.

What is ICD-10?
ICD-10-CM is the 10th revision of an international coding system used around the world. The United States, which currently uses ICD-9, will be one of the last major developed countries in the world to move to ICD-10, which the rest of the world has been using for the past 12 years or so.

ICD-10 is a product of the World Health Organization (WHO) for official collection of diagnostic data for world use. The United States uses the ICD system to code diagnoses for all healthcare encounters. When ICD codes are tied to the American Medical Association’s (AMA) Common Procedure Terminology (CPT) codes, appropriate payment can be returned to the practicing physician.

Why switch now?
Imagine trying to use an AMA CPT code book from 1979 to code procedures being performed in 2013. It had no codes for arthroscopy procedures. So many procedures have changed so significantly, orthopaedic surgeons would hardly be able to represent the work they do today using 1979 codes.

The current ICD-9 system is 34 years old, and to say it is outdated does not begin to cover the situation. It has no room for expansion and not enough detail in many codes. Many sections are obsolete and the system needs to be retired.

Although ICD-10 won’t go into effect until Oct. 1, 2014, the wise physician should start now to plan for implementation, train office staff, and assess what the true impact on the practice will be.

10 steps to success
As a broad outline, the following 10 steps will help ensure successful implementation of ICD-10 next year:

  1. Engage a team. The transition team should be headed by a physician and include the practice executive, coders, other office staff, and medical assistants. Those who document the medical record must be involved and begin training soon.
  2. Establish a plan. Actually, this is multiple plans, including one for education and training, one for assessing current documentation, one for conducting a gap analysis, and one for implementation. Watch for and participate in the AAOS educational program on ICD-10 transition and implementation later this year.
  3. Execute the plan.
  4. Conduct a gap analysis. A skilled consultant or team should take the top 25 to 40 diagnoses seen in the practice. Using current documentation, the team should code the same cases to ICD-10-CM, and see what is missing. The AAOS Code-X product will be very helpful.
  5. Get focused training. Send office staff to a seminar or hire a consultant to do specific onsite training, focused on orthopaedics and any specialty area of the practice.
  6. Follow through. Do this particularly on the clinical documentation improvement plan. Make the changes in your electronic health record system template. Capture the data you need for the specific and best code to be selected.
  7. Identify ICD code usage. Where does your practice use ICD codes? Identify all places where you use ICD codes, because all will need to be changed. Take advantage of the opportunity to make process improvements. How can the improvement in coding specificity be used?
  8. Continue testing. Education is not a one-time effort; it must be continuous.
  9. Champion the change. Be the physician champion in your office who is supportive of this change and indicate your willingness to provide a detailed diagnosis or diagnoses for coding.
  10. Celebrate your success.

Help is on the way
Future articles will deal with some of the ICD-10 coding changes, including using the Gustilo fracture classification, appropriately indicating sequelae, underdosing, combination codes, and the much maligned external cause codes.

As you make the transition, it is important to work with qualified people. Don’t be taken in by startups or individuals claiming to be “certified” in ICD-10-CM coding. For example, the American Health Information Management Association (www.ahima.org), is not “certifying” individuals in ICD-10-CM. But individuals who attend a comprehensive 3-day training program, complete two online courses, and pass a national exam do become “approved” trainers. That is what you want to look for as you seek coding help.

This is not a disastrous situation, and there is no reason to panic. Good clinical documentation is the foundation, and having a coder(s) trained in ICD-10-CM will help you through the transition.

Margaret A. Skurka, MS, RHIA, CCS, FAHIMA, is professor and director of the department of health information management at Indiana University Northwest. She can be reached at mskurk@iun.edu

Additional Resources
ICD-10 Resources

From ICD-9 to ICD-10
For 34 years, a closed, midcervical fracture of the femur has been coded as 820.02, using ICD-9.

ICD-10-CM requires additional detail—Is it the right femur or the left femur? Is this an initial encounter or a subsequent encounter? Is the fracture healing nicely or delayed? ICD-10 has four codes and your documentation must note which femur, what type of encounter, and whether a complication exists.

AP radiograph of a displaced femoral neck fracture (arrow). Under ICD-10, the code for this fracture will also indicate the side, initial or follow-up visit, and presence of complications.
Credit: Sarwark JF (ed):
Essentials of Musculoskeletal Care 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010, p. 563.

Note: ICD-10-CM, as with ICD-9-CM, always assumes the lesser level unless documentation says otherwise. If you don’t indicate the complication, the coder thinks there is none. If you don’t indicate an open fracture, the coder assumes closed, and you’ve lost documentation of the acuity of the injury.

Codes in ICD-10 always start with an alpha character so the choices look like this:

  • S72031A—displaced, midcervical fracture, right femur, initial encounter for a closed fracture
  • S72031G—same fracture, subsequent encounter, with delayed healing
  • S72032A—displaced, midcervical fracture, left femur, initial encounter for a closed fracture
  • S72032G—same fracture, subsequent encounter, with delayed healing