Start planning now for transition to ICD-10

The ICD-10-CM code set is scheduled to replace ICD-9-CM, the current U.S. diagnostic code set, on Oct. 1, 2013. While that date is in the far future, you should prepare now, coding experts warn.

"The planning stages for how to train staff should be in mind now," says Stephanie Ellis, RN, CPC, owner and president of Ellis Medical Consulting, a Brentwood, TN-based consulting firm surveying ambulatory surgery facilities and physician practices for coding and compliance. Ellis spoke at a recent ASC Coding Seminar sponsored by the Ambulatory Surgery Center Association.

You will need to provide significant education and training for physicians, coders, billers, and other health care staff to fully implement this major coding change, Ellis says. However, there is no need for coders to begin training immediately, she says. "Once ICD-10 is implemented, certified coders holding a credential with AAPC [the American Academy of Professional Coders] will have two years to pass an open-book, online proficiency test on ICD 10, which they must do to keep their coding certification," Ellis explains.

In many ways, ICD-10-CM is similar to ICD-9-CM, she notes. For example, the guidelines, conventions, rules, and organization of the codes are alike, Ellis says. "Coders, billers, and providers who are currently qualified to use ICD-9-CM codes should be able to make the transition to ICD-10 coding," she says. (For a comparison of the two systems, see graphic.)

There is one deadline that providers need to prepare for now, says Cristina Bentin, CCS-P, CPC-H, CMA, principal for Coding Compliance Management, a Baton Rouge, LA-based health care consulting company specializing in the markets of ambulatory surgery centers and surgical hospitals with emphasis on coding support, reimbursement, and training. "Ambulatory surgery providers should be aware that before ICD-10-CM/PCS can be utilized, systems need to first undergo system upgrades for HIPAA ASC [Accredited Standards Committee] X12 version 5010 transactions of which the Level 1 internal testing compliance deadline is Dec. 31, 2010," Bentin says. "Level 1 compliance is achieved when a covered entity can demonstrably create and receive compliant transactions."

While outpatient surgery providers don't need to panic, another item they need to examine early is the system used for coding and billing claims, Ellis says. "They need to check with their system vendor and be sure they will be doing whatever they need to do so that they will be ready to handle the change to ICD-10 in a timely manner," she says.

Providers should check with the clearinghouse they use for claims about the same issue, Ellis says. "They need to make sure that any coding software they use will be prepared in enough time to be usable with cross-coding tables for converting diagnosis and/or procedures in words to codes and ICD-9 codes to ICD-10 codes," she says.

Providers should check with their largest payers about dates of when they will expect their codes on claims to be filed using ICD-10 codes as well, Ellis points out. "Provider billing systems should have the capability to file claims with both ICD-9 and ICD-10 codes when the changeover first occurs, because not all payers will observe the same 'going live' date to accept ICD-10 codes," particularly Medicaid programs, who frequently are years behind any changes to codes due to budget issues, she warns.

For up to two years, systems will need to access ICD-9-CM and ICD-10-CM codes, as providers transition from one system to the other. Mapping will be necessary to find equivalent codes for purposes of disease tracking, medical necessity edits, and outcomes studies.

There's much preparation needed, Bentin says. "Many ambulatory surgery [providers] are overwhelmed at the thought of converting to ICD-10," she says. However, there are multiple resources, including the American Health Information Management Association (, she says. "Education is the biggest challenge for the facility," Bentin says. "Coders should begin familiarizing themselves with ICD-10 now rather than later."


What's the reason for a new diagnosis system?

CMS predicts fewer rejected claims

The United States is implementing ICD-10 because the ICD-9-CM has several problems, primarily that it is out of room for expansion, says Stephanie Ellis, RN, CPC, owner and president of Ellis Medical Consulting, a Brentwood, TN-based consulting firm surveying ambulatory surgery facilities and physician practices for coding and compliance.

"Medical science keeps making new discoveries, and there are no numbers to assign these diagnoses," she says. "The more detailed ICD-10 codes will help streamline claims submissions by making claims much easier for payers to understand."

ICD-10-CM increases the number of codes from about 13,000 codes in the ICD-9-CM for diagnoses to 68,000 ICD-10-CM codes. The ICD-10-CM codes are up to seven characters in an alpha-numeric system.

The Centers for Medicare & Medicaid Services (CMS) lists the long-term benefits of ICD-10-CM to be:

— ICD-10 codes can better accommodate new procedures. An estimated 1% of all procedures each year are new.

— There are expected to be fewer improper and rejected claims using ICD-10.

— ICD-10 offers improved disease management.

— ICD-10 offers an improvement in disease monitoring worldwide, because most other countries already are using ICD-10-CM codes.