Ready or Not, ICD-10 Becomes Real in Twenty Days!

Ready or Not, ICD-10 Becomes Real in Twenty Days!

The ICD-9 is showing its 40+ year age. Side by side, the ICD-9 is a calculator compared to the ICD-10 computer. A vast amount of research, discovery and development has occurred in the past 40 years, and the ICD-9 has no capacity to collect or record this new information in a statistically relevant way. And, not insignificantly, the ICD-9 does not adequately respond to the needs of American medical practices and payers.  After a ten year delay in implementation, and an additional year to address compensation challenges, it appears that October 1, 2015 will indeed be the day when ICD-9 is fully replaced by ICD-10.

The American Academy of Ophthalmology recommends “all physicians covered by the Health Insurance Portability and Accountability Act must switch to ICD-10 by Oct. 1, 2015. Practices should use ICD-9 codes through Sept. 30, 2015 while continuing to prepare for the transition. Failure to convert to ICD-10 by the deadline could jeopardize almost all of a practice’s payments.”

By now, all ophthalmology practices should be ready for the transition to the new coding matrix contained in the ICD-10. The primary difference between the two systems is that the ICD-10 introduces many more codes allowing it to convey more detail than the ICD-9. Codes will be more specific, requiring physicians to include more information in the medical record to support them. For eye care professionals, that means adding code specificity for right eye versus left eye, initial encounters versus subsequent encounters and other added differentiations. Accounting for each aspect of care will require more detailed, ICD 10-specific documentation beginning with the first visit. Until the doctor is comfortable with the changes in coding, documentation of eye assessments and diagnoses may take more time to complete.

The differences between ICD-10 and ICD-9 are significant. ICD-9 specified no laterality. Codes are 3-5 digits: Digit 1 is alpha (E or V) or numeric, Digits 2-5 are numeric, and a decimal is placed after the third character. The approximate 14,000 codes allowed no placeholder characters. The system accommodated limited severity parameters, limited combination codes and only one type of excludes notes.

In contrast, ICD-10 allows for laterality specification. Codes are now 7 digits: Digit 1 is alpha, Digit 2 is numeric, and Digits 3–7 are alpha or numeric. A decimal is placed after the third character. The new system allows “X” placeholders and provides approximately 69,000 codes to better capture specificity. It allows extensive severity parameters and combination codes as well as two types of excludes notes. Besides differences in the codes themselves, there are other major differences in the two code sets. Injuries are grouped by anatomical site now, rather than by type of injury. The main classification will now include E and V codes to indicate factors influencing health status and health services as well as external causes of injury and poisoning (formerly indicated in supplementary classification). In some cases, the new code definitions reflect changes to updated modern medical practice. A number of chapters have restructured categories and reorganized codes, changing how certain diseases and disorders were classified. Other diseases were reclassified to different chapters or sections to better reflect current medical knowledge.

It is this 500+% expansion that is causing such challenge because it requires an overhaul of virtually every aspect of medical practice and reporting. The expectation is that more specific billing codes will improve the accuracy of medical data reports. The use of precise billing codes may also reduce incidents of fraud and waste, which is so rampant in the current medical billing industry.

Coding acts as the nexus between payers and practices. The biggest challenge to all medical practices as they implement ICD-10 will be coordinating the various practice components through the transition. Changes in coding will affect all levels of in-house staff, each of which contributes an element to the overall service record. Outside vendors also need to participate, as their services and supplies will now be classified differently. Incomplete or insufficient billing will cause delays and potential losses through uncaptured transactions. Getting it right before the October 1 deadline will keep practices running smoothly.

Obviously, a 40-year-old car is no longer a viable transportation option. A 40-year-old medical recording system is equally obsolete. The ICD-10, with its comprehensiveness and adaptability capacity, leaves the ICD-9 in the dust.