ICD-10: Prepare to avoid disruption

Q. What training will my billing department need for ICD-10?
Thursday, May 24, 2012

A. Since ICD-10 codes will have an expanded character set, the change from ICD-9 will be a disrupter. With a higher level of detail, diagnosis codes will become more clinical in nature, and while HCPCS codes will not change, diagnosis connections will. Most importantly, doctor’s orders and CMNs may need to be updated for new ICD-10 diagnostic codes for recurring orders for dates of service after the proposed Oct. 1, 2014, effective date. 

Adding to the complexity, for a period of time ICD-9 and ICD-10 code systems will operate concurrently. The proposed rule requires that as of Oct. 1, 2014, new diagnoses must be entered with ICD-10 codes. However, if a recurring order is placed previously, it will be entered under ICD-9 with subsequent orders using ICD-10. Clarification on how long earlier diagnosis codes under the ICD-9 system need to be maintained is pending.

So what does this mean? Early planning will be critical.

Staff must understand new rules of engagement for codes and documentation. Because codes will become more clinical, familiarity with anatomy and physiology will help staff better understand diagnoses to properly assign therapies.

Even with preparation, change can bring the unexpected. It will be important to plan for managing an increased level of inbound/outbound calls related to claims and denials.

At a minimum, data management systems must be ready for the expanded codes. It will also need to accurately handle both coding systems, especially for recurring sales that span the implementation date, and have the intelligence to know when a new CMN is required based on new rules. HME

Gregg Timmons is president and CEO of MedAct Software. Reach him at gtimmons@medactsoftware.com or 800-326-0314.