8 Things You Need to Know Now About ICD-10

Earlier this month, WebPT Co-Founder Heidi Jannenga, PT, discussed her key takeaways from June’s HIMSS ICD-10 Conference in Washington, DC. This massive change is quickly approaching, and it affects all of us. Thus, there is no time like the present to start your ICD-10 education. Here are the eight things you need to know now about ICD-10:

1. ICD-10 will replace ICD-9.

In a little over a year, you will no longer report the diagnosis codes you know as ICD-9, which are code sets consisting of three to five characters with a decimal point (e.g., 813.15). Instead, you will use International Classification of Diseases, 10th Revision (ICD-10), which uses three to seven characters in an alpha-numeric combination. In addition to a different code structure, there are about five times as many ICD-10 codes as ICD-9 codes. This will ensure an intense level of specificity in coding diagnoses.

2. The change is necessary.

The US is the last country in the world with modern health care to adopt ICD-10 diagnosis codes. But playing catch up isn’t the only reason why shifting to ICD-10 is necessary. According to a CMS ICD-10 introduction, the US must transition to ICD-10 because:

• “ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures.”
• “ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice.”
• “The structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.”

3. The change is mandatory.

According to CMS, you won’t get paid for any claims of services after October 1, 2014, if you use ICD-9 codes. Alternatively, payers will not accept ICD-10 codes for payment before the implementation date. Thus, all claims for services provided before October 1, 2014, must contain ICD-9 diagnosis and procedure codes. (Of course, now October 1, 2014, has become October 1, 2015.)

4. The start date is now October 1, 2015.

Because of HR 4302, ICD-10 will now go into effect on October 1, 2015. That means (to clarify point number three) you will use ICD-9 diagnosis codes for all claims of service until September 30, 2015.

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5. ICD-10 will not replace CPT codes.

ICD-10 codes are diagnosis codes. CPT codes are billing codes. Both go on your claim. However, according to this CMS resource, “The change to ICD-10 does not affect CPT coding for outpatient procedures.” To be clear, “ICD-10 diagnosis codes must be used for all health care services provided in the U.S., and ICD-10 procedure codes must be used for all hospital inpatient procedures.”

6. ICD-10 does affect you.

I know I’m quoting CMS a lot here, but ICD-10 affects everyone covered by HIPAA—not just those who submit Medicare or Medicaid claims. Thus, ICD-10 affects all rehab therapists as well as all other providers, payers, clearinghouses, and billing services. In short, if you deal with HIPAA, buckle up because you’re switching to ICD-10.

7. You need to start preparing.

The idea of readying yourself for this change can seem more than overwhelming. Hello, 68,000 diagnosis codes! But the earlier you start, the more time you’ll have to get all your ducks in a row. Here are some pointers:

1. Develop an implementation strategy. Make sure you assess the impact on your organization, develop a detailed timeline, and plan a budget.
2. Check with your billing service, your clearinghouse, and all of your vendors about their implementation and compliance plans. If you handle billing internally, make sure your coding, clinical, IT, and finance staff are involved in the planning of and preparation for your practice’s transition.

For more preparation advice, check out this detailed planning and preparation checklist from the American Health Information Management Association.

8. WebPT will be ready.

Heidi’s attendance of June’s HIMSS conference was just the beginning. We’re diving into all this meaty ICD-10 material as we gear up for this important transition. Just like functional limitation reporting, though, we’ll be ready well in advance—and we’ll provide the entire rehab therapy community with a wealth of free educational resources on the topic.