October 1, 2013 should be on the mind of every physician in the U.S. That is the day when a new diagnostic coding system will be instituted, the first such change since 2003. The implementation’s aftermath is predicted to be anywhere from a normal day at the office to financial Armageddon.
Explore This IssueDecember 2011
“It is imperative that practices begin to think strategically and figure out what needs to be done and how to pay for it,” said Rhonda Buckholtz, CPC, CPMA, CENTC, vice president of ICD-10 education and training for the American Academy of Professional Coders (AAPC).
In January 2009, the U.S. Department of Health and Human Services released new standards for adoption of the International Classification of Diseases, Tenth Revision (ICD-10). ICD-10 CM (Clinical Modification) will be used in all health care settings. ICD-10 PCS (Procedure Coding System) is used only in the inpatient hospital setting. After October 1, 2013, the old ICD-9 codes will not be usable for billing in most health care settings.
New Codes for New Times
According to the Centers for Medicare and Medicaid Services (CMS), the transition to ICD-10 is occurring because ICD-9 produces very limited data about patients’ medical conditions and hospital inpatient procedures. In addition, the three to five-digit structure of ICD-9 limits the number of new codes that can be created. Over the years many ICD-9 categories have become full, making it even harder to capture the full nature of diseases in the U.S. The ICD-10 transition will include seven-character codes.
“ICD-9 is completely outdated,” Buckholtz said. “Not only is there a need for more codes, but [there is] a lack of space for new codes.”
This means that the 17,000 different codes currently used in ICD-9 will grow to more than 140,000 when ICD-10 is fully implemented. In addition, the new codes require more specificity in coding and documentation. One code currently used for acute otitis externa, for example, becomes 28 potential codes.
“We are the U.S. and the king of supersizing,” Buckholtz said. “We have taken our clinical modification of ICD-10 to a higher level than other countries. For example, in Australia they have around 16,000 codes, while Canada and Germany have under 20,000.”
In addition, the U.S. is the only country using the ICD-10 system for billing purposes. Most of the other nations use it mainly for epidemiological reasons. Canada is among those countries that use it only in hospitals.