Deadline for conversion to ICD-10 Codes Set for October 1, 2015: Are You Ready?

By Arthur D. Leritz, Attorney at Law

There are few certainties in life – death and taxes sure, but also add converting ICD-10 to that list.  The U.S. Department of Health and Human Services issued a statement July 31, 2014 finalizing October 1, 2015 as the new compliance date for healthcare providers.    So what does this mean for your practice?  If you are like me, you shudder at the thought of “upgrades” to systems that are supposed to make processes simpler.

This transition to ICD-10 is required for everyone covered by HIPAA, not just those who submit Medicare or Medicaid claims.  This also means that claims submitted to Medicare and Medicaid after the deadline will not be processed.  The ICD-10 transition does not affect the CPT coding for outpatient procedures and physician services.  The ICD-10 system has two parts:

  1. ICD-10-CM for diagnosis coding; and
  2. ICD-10-PCS for inpatient hospital procedure coding.

Diagnosis for ICD-10-CM uses 3 to 7 alphanumeric digits instead of the 3 to 5 numerical digit system with ICD-9-CM.

Below are links to websites that contain excellent information about the transition:

http://www.cms.gov/Medicare/Coding/ICD10/

Background/General ICD-10 Information:

http://www.roadto10.org/quick-references/

ICD-10 Checklists, Guides and Timelines for large and small practices:

http://cms.gov/Medicare/Coding/ICD10/ProviderResources.html

The following is a link that will show you the new codes by specialty:

http://www.roadto10.org/

Also, in my research on this issue I found a very useful website that will convert ICD-9 codes to ICD-10 codes for you:

http://www.icd10data.com/Convert

I cannot vouch for the accuracy or reliability of this website, but it is a great way to get started.  (I did cross-reference the search results with the information on www.roadto10.org and the codes searched were the same.)  For example, I plugged in some common codes I see on cases and came up with the following tables:

Neck and Back Pain:

ICD – 9-CM: ICD – 10-CM:
1. 723.1  (Cervicalgia) M54.2 (Cervicalgia)
2. 724.1  (Pain in Thoracic Spine) M54.6 (Pain in Thoracic Spine)
3. 724.2  (Lumbago) M54.5 (Low Back Pain)
4. 724.3  (Sciatica) M54.30 (Sciatica, unspecified side);or M54.31 (Sciatica, Right Side); or M54.32 (Sciatica, Left Side)
5. 724.5  (Backache, unspecified) M54.89 (Other dorsalgia); or M54.9 (Dorsalgia, unspecified)

Thoracic, Thoracolumbar and Lumbosacral Intervetebral Disc Disorders:

ICD – 9-CM: ICD – 10-CM:
1. 722.10 (Displacement of lumbar disc without myelopathy): M51.26 (Other intervertebral disc displacement, lumbar region); or M51.27 (Other intervertebral disc displacement, lumbosacral region)
2. 722.11 (Displacement of lumbar disc with myelopathy): M51.24 (Other intervertebral disc displacement, thoracic region); or M51.25 (Other intervertebral disc displacement, thoracolumbar region)
3. 722.31 (Schmorl’s nodes, thoracic region): M51.44 (Schmorl’s nodes, thoracic region); or M51.45 (Schmorl’s nodes, thoracolumbar region)
4. 722.32 (Schmorl’s nodes, lumbar region): M51.46 (Shmorl’s nodes, lumbar region); or M51.47 (Schmorl’s nodes, lumbosacral region)
5. 722.51(Degeneration of thoracic or thoracolumbar intervertebral disc): M51.34 (Other intervertebral disc degeneration, thoracic region); or M51.35 (Other intervertebral disc degeneration, thoracolumbar region)
6. 722.52(Degeneration of lumbar or lumbosacral intervertebral disc): M51.36 (Other intervertebral disc degeneration, lumbar region); or M51.37 (Other intervertebral disc degeneration, lumbosacral region)
7. 722.72 (Intervertebral disc disorder with myelopathy, thoracic region): M51.04 (Intervertebral disc disorders with myelopathy, thoracic region): or M51.05 (Intervertebral disc disorders      with myelopathy, thoracolumbar region)
8. 722.73 Intervertebral disc disorder with myelopathy, lumbar  region): M51.06 (Intervertebral disc disorders with myelopathy, lumbar region)
9. 722.90 (Other and unspecified disc disorder, unspecified region): M46.40 (Discitis, unspecified, site unspecified); or M51.9 (Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder)
10. 722.92(Other and unspecified disc disorder, thoracic region): M46.45 (Discitis, unspecified, thoracolumbar region); or M51.84 (Other intervertebral disc disorders, thoracic region); or M51.85 (Other intervertebral disc disorders, thoracolumbar region)
11. 722.93 (Other and unspecified disc disorder, lumbar region): M46.47 (Discitis, unspecified, lumbosacral region); or M51.86 (Other intervertebral disc disorders, lumbar region); or M51.85 (Other intervertebral disc disorders, lumbosacral region)
12. 724.40 (Degeneration of cervical disc): M50.30 (Other cervical disc degeneration, unspecified cervical region)
13. 847.2 (Sprain of the lumbar region): S33.5XXA[1]

 

For providers who have not yet started the transition to ICD-10, The Center for Medicare Services (CMS) recommends the following:

  • Establish a transition team or ICD-10 project coordinator, depending on the size of your organization, to lead the transition to ICD-10 for your organization.
  • Develop a plan for making the transition to ICD-10; include a timeline that identifies tasks to be completed and crucial milestones/relationships, task owners, resources needed, and estimated start and end dates.
  • Determine how ICD-10 will affect your organization. Start by reviewing how and where you currently use ICD-9 codes. Make sure you have accounted for the use of ICD-9 in authorizations/pre-certifications, physician orders, medical records, superbills/encounter forms, practice management and billing systems, and coding manuals.
  • Review how ICD-10 will affect clinical documentation requirements and electronic health record (EHR) templates.
  • Communicate the plan, timeline, and new system changes and processes to your organization, and ensure that leadership and staff understand the extent of the effort the ICD-10 transition requires.
  • Secure a budget that accounts for software upgrades/software license costs, hardware procurement, staff training costs, revision of forms, work flow changes during and after implementation, and risk mitigation.
  • Talk with your payers, billing and IT staff, and practice management system and/or EHR vendors about their preparations and readiness.
  • Coordinate your ICD-10 transition plans among your trading partners and evaluate contracts with payers and vendors for policy revisions, testing timelines, and costs related to the ICD-10 transition.
  • Talk to your trading partners about testing, and create a testing plan. [2]

 


[1] “A” is for initial encounter, “D” is used for subsequent encounter and “S” is used for Sequella.  For “XX”, use 11 for Right, 12 for Left.
[2] http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10FAQs2013.pdf