ICD-10 (CM/PCS): The Fear of the Unknown?

The implementation of ICD-10 for diagnosis reporting in the United States has been talked about for many years. Since being developed and adopted by the World Health Organization (WHO) in 1994 many wondered if it would ever happen at all. In 1999, the United States implemented ICD-10 for mortality (the reporting of death certificates); however, the use of ICD-10-CM (the U.S. diagnosis coding system) and the development of ICD-10-PCS for procedure reporting in the U.S. was still a while away from being completed.

After undergoing several clinical modifications of ICD-10 by the National Center of Health Statistics (NCHS) and development of ICD-10-PCS by 3M Health Information Management for the Centers for Medicare and Medicaid Services, the dual coding system was one step closer to national rule making.

On January 19, 2009, the Department of Health and Human Services published in the Federal Register,45 CFR part 162, the final rule making on ICD-10, mandating that all HIPAA covered entities adopt ICD-10-CM and ICD-10-PCS by compliance date of October 1, 2013. ICD-10-CM will be required for entities reporting diagnosis codes and ICD-10-PCS will be required for hospitals reporting procedure codes. The change is coming and the compliance date is firm!

Since the release of the final rule on ICD-10, there has been much buzz on the Internet and talk about the rush for ICD-10 readiness and training. This buzz has created fear and trepidation in most and rightfully so. The implementation of ICD-10 in the United States is the biggest and most significant thing to happen to the healthcare industry in most of our professional careers so far. Not only will HIPAA covered entities be required to implement ICD-10, many other facets of healthcare will need to prepare for the change as well to accommodate the needs of their HIPAA covered clients. For example, software vendors will need to update their products to be ICD-10 (CM/PCS) compliant.

While many of the larger healthcare institutions have long started preparing for ICD-10 since release of the Final Rule, there are still many, particularly smaller practices that are lagging behind. There is the misconception that implementation of ICD-10 will be put off [again] closer to the compliance date. That is a myth! The compliance date is firm! No delays and definitely no grace periods.

Now that ICD-10 implementation is less than two years away, there is a heightened sense of urgency and fear of not being fully compliant by October 1, 2013. As Franklin D. Roosevelt once quoted, "there is nothing to fear, but fear itself". Well, the same can be said about the upcoming implementation of ICD-10. In many cases, fear usually reflects a lack of knowledge, which can easily be overcome by gaining an understanding of the subject matter. In respect to ICD-10, once you understand the nuances of the overall project, have a solid strategy and allow ample time for planning, then any notable fears will be greatly reduced.

One of the best ways to calm this fear and move forward with your ICD-10 implementation project is to educate yourself about all there is to know about ICD-10 and prepare&now! There are many resources available to assist with ICD-10 readiness and training. The National Center for Healthcare Statistics (NCHS) and The Centers for Medicare and Medicaid Services (CMS) provides a wealth of information on their websites.

So, whether you are a healthcare institution or a small physician practice, there are many steps you can take now to prepare for ICD-10's inception. Here are some of the basics that you should be taking or should have taken by now.

Basic steps to prepare for ICD-10 readiness:

The size of the organization or practice will depend on how detailed the implementation strategy will be. So, each of the basic steps mentioned above should be assessed at a more granular level.

Coder's standpoint

As coding professionals, your role is vital to the upcoming ICD-10 implementation. Those with a strong foundation in ICD-9-CM will likely have a seamless transition to ICD-10-CM. It's essentially ICD-9-CM, but all grown up, is how I like to put it. However, the same cannot be said about ICD-10-PCS, it's a completely new procedural coding system. Even the most proficient ICD-9-CM-volume 3 coders will need to learn this new coding system from scratch, and that can also bring about some fears. As with healthcare organizations, coding professionals can also take steps to prepare for the transition. It is important to note that CMS recommends waiting until at least six months prior to the compliance date to provide detailed code set training the HIM staff and coding professionals since the ICD-10-CM/PCS codes sets will not be used until the compliance date. And remember, "What you don't use, you lose".

However, there are some preliminary steps coder's can take to prepare for code set training and implementation. The best way to calm fears is to educate yourself on the subject matter and plan ahead. Here are some of the basics

Basic steps coder's can take now to prepare for ICD-10:

Embrace the change

Implementation of ICD-10 will bring on new challenges and new opportunities. ICD-10 (CM/PCS) is inevitable and the compliance date of October 1, 2013 is firm. So, embrace the change and remember we are all in this together.

1. Federal Register, 45 CFR part 162, Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA); Final Rules
2. Centers for Medicare and Medicaid Services (CMS): www.cms.gov/ICD10
3. National Center of Health Statistics (NCHS): www.cdc.gov/nchs

Simone M Johnson, BA, CPC, CPC-H, CPC-P, CPC-I, has over 20 years of combined healthcare coding and reimbursement experience to include: Physician and Outpatient Hospital Coding and Auditing, Medical Policy Development, Revenue Management, Healthcare Claim Analysis, Governmental Policy and Regulations, and Coding Education. She is the owner of PhysiCode Healthcare Services, LLC, a company that provides medical coding training and healthcare consultant services. Simone is also an AHIMA-Approved ICD-10-CM/PCS trainer and licensed PMCC instructor. Contact Simone at sjohnson@physicode.com: www.physicode.com