With 68,000 Codes and So Little Time, Are You ICD-10 Ready?

Written by: Kimberly Commito on Monday, June 15, 2015 Posted in: HME/DME, Home Infusion, Specialty Pharmacy

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If you are in the business of healthcare, you know about International Classification of Diseases (ICD) codes. And you’ve surely heard that, although the proposed 2014 adoption was postponed, the 10th edition, known as ICD-10, is scheduled for October 1, 2015 implementation. With some 68,000 codes—compared to just 14,000 for ICD-9—the thought of transitioning to what some have called a cumbersome new system must be frightening!

Adding to that fear are continued assurances from the U.S. Department of Health & Human Services (HHS) that the rapidly approaching October deadline is firm and will not be pushed back again. This means that your HME/DME business must be ICD-10 ready, or your claims for all dates of service starting October 1, 2015 will not be paid. Clearly, you can’t afford to delay any longer because the clock is ticking, literally.

The Challenge:
Although many ICD-9 codes will map directly to ICD-10 on a one-to-one basis, most ICD-9 codes will translate to several possible ICD-10 options because of the more specific nature of ICD-10 coding. ICD-9 codes that don’t translate directly will require clinical intervention to analyze the various ICD-10 options. In addition, some ICD-9 codes will have no GEMs results whatsoever, so translating these codes will involve additional research and clinical intervention. During the conversion process, you may want to have staff members who are proficient in anatomy and physiology review the codes that map “one-to-many” and make the initial ICD-10 selection. The final selection should be made by a clinician before committing the ICD-10 code to the patient’s record. See below for one example explaining the coding changes that may require clinical analysis and research.
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We also recommend that you develop a monitoring process to keep track of patients whose codes have not been converted and for whom you may need to gather additional information to make a clinically accurate decision. Obtaining this additional information may include detailing a medical and surgical history and/or reviewing the hospital medical records and contacting the physician for a final decision. Additional documentation in your patient record may be needed to support the ICD-10 code decisions.

ICD-10 code management tools have been built in to all of the Mediware home care solutions. These tools allow our customers to identify suggested replacements for ICD-9 codes with ICD-10 codes based GEMs results. The utility tools assist in keeping track of which codes converted successfully, which did not, and which require appropriate personnel to evaluate and assign the correct ICD-10 code.

For more in-depth information about getting ready for ICD-10 implementation, go to Mediware’s ICD-10 Resource Center: https://www.mediware.com/icdten

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