Transitioning to ICD-10 by Carol J. Buck

Mandated Transition

Over 99 percent of Medicare Part A (inpatient) claims and over 96 percent of Medicare Part B (outpatient) claim transactions are received electronically (www.cms.gov/Versions5010andD0/downloads/w5010BasicsFctSht.pdf). The 5010 electronic data interchange (EDI) is ICD-10 compatible and the government requires the claims be submitted via EDI. Although some prominent organizations have come out against the implementation of ICD-10, the transition is a mandate that is scheduled to take place October 1, 2014, and health care facilities and providers are in the final stages of gearing up for the transition. Canada has already transition to ICD-10 as have most nations; further, ICD-11 is already in global pilots. The ICD-9 had limited expandability based on the structure of the coding system and literally the system is out of numbers to assign. Unless some unforeseen political event occurs, the ICD-10 is a scheduled mandate that we all need to prepare for.

A successful transition from ICD-9 to ICD-10 is not an impossible task! For the facilities and providers, the transition is expensive and time consuming as there must be software revisions and system integrations, but in the classroom, the revision is the curriculum content, which is not a difficult task. The critical issue for the classroom is the timing of the transition.

More Codes

The primary difference between the code systems is ICD-10 has more codes — approximately five times more codes — and these additional codes provide greater detail. For example, where there may have been two codes from which to choose to assign a diagnosis of a fracture, there may be 20 or more codes from which to choose. The increase reflects laterality (left/right) or incident of service (initial/subsequent), and other key factors. The increased number of codes makes the assignment of the code more specific not more difficult. The medical documentation must, however, reflect all the detail necessary to correctly assign a code.

In addition to having more codes in the ICD-10, and the format of the manual has changed.

The ICD-9-CM was contained in one manual with three volumes:

• Index of Diseases (Volume 2, the index)
• Tabular of Diseases (Volume 1, the codes)
• Procedures (Volume 3 inpatient surgical procedures and therapies)

The ICD-10 is contained in two manuals:

• ICD-10-CM with Index of Diseases and Tabular of Diseases
• ICD-10-PCS (Procedural Classification System)
• The new system is presented in table format and represents the most dramatic change in the entire coding system.

When to Transition

There are two questions to consider before developing an implementation plan to transition to ICD-10:

1.  When is the student entering the job market? 

• Between now and January 2014, the student should have a working knowledge of ICD-9 and a basic knowledge of the ICD-10.
• After January 2014, the student should have a working knowledge of both ICD-9 and ICD-10
• Employers want graduates to have ICD-9 knowledge from January to October, 2014, because transactions will be ICD-9 based until October 1, 2014, when transactions will begin to be ICD-10 based.

2.  Is the student preparing for an AHIMA or AAPC examination? 

• Examinations are to be ICD-10 based as follows:
• AHIMA, April 1, 2014, begins ICD-10 based examinations
• If the examinee takes an AHIMA certification exam prior to April 1, 2014, the examinee must acquire continuing education units (CEUs) in ICD-10 as follows:
• CHPS – 1 CEU
• CHDA – 6 CEUs
• RHIT – 6 CEUs
• RHIA – 6 CEUs
• CCS-P – 12 CEUs
• CCS – 18 CEUs
• CCA – 18 CEUs
• AAPC, January 1, 2015*, begins ICD-10 based examinations
• The examinee that takes the ICD-9 based AAPC certification examination must take and pass a 75-question ICD-10 proficiency examination. The proficiency examination will be available October 1, 2013 through October 1, 2015. The exam costs $75 and is an open book, online examination. The examinee has until 2015 to successfully pass the examination.



*Projected dates based on previous date of when ICD-10 was to be published October 1, 2013.