New 2015 ICD-10 Procedure Codes: What to Know and How to Prepare
July 14, 2014
•Medical Billing and Coding, General
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The new International Classification of Diseases procedure and diagnostic codes are set to take effect on Oct. 1, 2015. It's the first time in 30 years that the United States has updated its coding system, moving from the current ICD-9 codes to the ICD-10 codes. This major change means almost everyone who works in the healthcare industry will be affected. Whether you're considering a degree in medical coding or you currently work in the field, here's what you should know about this change and how best to be prepared.
What are ICD-10 Procedure Codes?
The ICD-10 is the 10th edition of the coding system created by the World Health Organization to classify the full scope of human medical conditions and procedures. These codes are used by medical coders, billers and physicians for inpatient and outpatient treatment. There are two parts: the ICD-10 Clinical Modification coding system (CM), which is the diagnostic coding system used in all healthcare settings, and the ICD-10 Procedure Codes System (PCS), which is used only in inpatient care settings. These might sound technically complex at first, but it helps to remember what each ending means:
- CM means diagnostic codes. Diagnosis codes include a specific anatomical location and depth of condition, as in Stage I or Stage II of a condition, for example.
- PCS refers to procedure codes. Procedure codes include the procedural approach, location of body where the procedure was performed and the instruments used.
Differences Between the ICD-9 and ICD-10
The ICD-9 system uses about 14,000 codes. But the new ICD-10 system has about 64,000 codes — more than four times the number of ICD-9. Though there's a huge increase in the number of codes in the new system, the coding structure has been simplified.
The ICD-9 system is structured numerically, with three to five digits in a code, whereas the new ICD-10 system is alphanumeric, organized alphabetically with three to seven digit codes. This makes it simpler to navigate and allows for more specific diagnostic and procedural information.
Why the Update?
The ICD-10 is a major change in how offices and doctors code, but there are practical reasons for the update:
- There have been so many new medical discoveries and advancements since the inception of ICD-9 that the system no longer provides the most accurate codes. With more codes and digits within the codes, the ICD-10 ensures both medical conditions and reasons behind these conditions can be clearly noted.
- More concise coding creates more relevant tracking of disease patterns, providing researchers with a better understanding about a condition's cause or which preventive measures could be best.
- Because of the codes' specificity, the new coding system will make it easier for payers, such as insurance companies, to understand and pay claims faster.
What's the Impact?
The new coding system affects those covered under the Health Insurance Portability and Accessibility Act — the majority of both health care providers and users in the United States. It's important to know that there is no grace period for the effective start date of Oct. 1, 2015. All physician offices and hospitals must start using the new coding system on that date. Otherwise, claims will not be paid.
However, since only inpatient facilities will need to move to the updated ICD-10 PCS codes, outpatient facilities and most doctors offices will need training only on the ICD-10 CM codes. Outpatient facilities, departments and physicians offices will continue to use the Current Procedural Terminology codes used in these offices, and these codes will not change.
Also, seasoned coders and medical coding students alike will need to know both the ICD-9 and ICD-10 codes while claims with ICD-9 codes cycle out of the system. This transition is expected to take about two years.
Still, the new system will most affect information technology and coding productivity. To be ready for the change, physicians' offices must make sure their software is up-to-date. Updated electronic records and proper entry will affect how quickly claims are processed and when offices get paid. So, doctors will need to make sure their documentation is correct. Doctors offices can also expect to pay a significant amount of money in new software and training to comply with the new regulations.
How to Prepare
Medical coding students should be certified in both ICD-9 and ICD-10 codes. Also, because ICD-10 codes use more specific anatomical terms, it's recommended that students have a sound understanding of anatomy and physiology. Those considering coding for specialty medicine, where many coding updates will occur, should become certified in these specialties.
Like students, medical coders will also need to know both the old and new systems and become certified in specialty areas. Offices and practitioners should divide their preparation between implementation training and coding training.
There are many resources to help guide you through the transition, and it is recommended to start preparing for the update as early as possible. Break the training into a series of steps along a time line. The American Association of Professional Coders developed a five-step training program to be prepared for the update, which includes:
- Anatomy and physiology training
- Code set training
- Specialty coding set
- Proficiency exam
The training allows you to pace yourself and tracks your progress according to a time line and the results of the proficiency exam. Whichever training program you decide to use, it is important to give yourself as much time as possible.
ICD-10 compliance is a hot topic in the industry right now, and there has been a lot of concern about how best to prepare. Starting as early as possible and identifying how your office can make the smoothest transition should be a priority. If you pace yourself and stay in the loop, the transition between systems will become much easier.
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