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U.S. health care coding changes today for first time in 30 years

After years of preparing and postponing, the new method for International Classification of Diseases starts today, changing health care coding in the United States for the first time in more than 30 years.

And, it’s for real this time. Although health systems were preparing for the switch last year, it is finally happening in the United States; the last industrialized country to make the change.

Here are 10 things to know about the 10th version of the International Classification of Diseases

1. The difference between ICD-9 and ICD-10

An example from Debra Cotter, Highmark Health’s project director overseeing ICD-10 implementation: Under ICD-9, if you break your arm, there could be other details, but for coding purposes, you broke your arm.

Now, under ICD-10, coding will also need to document whether it was the right arm or left arm.

Essentially, it is more specific. There is a total of 155,000 codes in ICD-10.

To break it down, there are 87,000 ICD-10 procedure codes compared with 3,000 codes in ICD-9. For diagnosis, ICD-9 had 13,000 codes and ICD-10 has 68,000.

2. The benefit of new coding

 Data. Data. Data.

According to Cotter, the ICD-9 coding methodology has been maxed out. As the medical field develops, there’s no way to recognize new procedures and other things. An example: the Ebola outbreak. There was no code for that.

“So, that worldwide epidemic that other countries were able to cite stats and info on, because the U.S. didn’t have a code for it, we couldn’t track Ebola,” Cotter said.

The goal of new coding is to improve health care initiatives by addressing gaps in collecting patient health information for research and public health reporting. It will also base the payment system on quality and outcomes.

“It gives you a deeper, richer base of information for health care, whether it be in the private sector or the public sector,” said Mary Ellen Corum, director of practice support for the Pennsylvania Medical Society. “More information helps everybody make better decisions.”

3. Who creates ICD-10 codes?

The ICD-10 Coordination and Maintenance Committee, which is an interdepartmental committee consisting of representatives from the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention’s National Center for Health Statistics. It is responsible for approving coding changes and developing modifications to ICD-10, according to information provided by Highmark Health.

4. Who’s affected by ICD-10?

According to the CMS website, “The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act, or HIPAA.”

5. Highmark Health preparations

Highmark Health started preparing for ICD-10 in 2010 by doing an impact analysis and looking at all facets of the business to understand where codes are used. The assessment report was more than 500 pages long.

Next, a project plan was built, and actual changes started in 2011.

By 2013, internal and external testing began.

Internally, there was a lot of parallel testing, examining ICD-9 code processing with ICD-10 to make sure everything was functioning correctly.

Externally, Highmark did end-to-end testing with providers and facilities by practicing ICD coding with them. This included creating medical records, submitting claims and completing the process.

6. PAMED preparations

PAMED provided physicians with the resources they need to minimize any hiccups. Workshops were held, and a whole piece of the organization’s website was given over to relevant materials and tools.

“I think all of our physicians are ready to go,” Corum said. “The vast majority are feeling comfortable. We dedicated a lot of time here in practice support.”

7. Who’s not required to switch?

One possible wrinkle, according to Corum, is that groups that are not HIPAA compliant are not required to switch. Workers’ compensation or auto company claims could actually continue to use ICD-9. This could force practices to stay in both worlds, according to Corum. Providers will have to contact payers to find out what code is being used.

8. Other concerns about ICD-10

Neither PAMED nor Highmark expects more claims will be rejected as a result of the coding change, because everyone has had so much time to prepare.

“It could be 18 months to two years until we are fully fluent and understanding of trends,” said Cotter at Highmark.

With so many things happening in the health care industry, such as open enrollment approaching and the industry still riding the Affordable Care Act wave, the most difficult part will be identifying what is directly related to ICD-10 and what is an aftereffect of something else, according to Cotter.

9. Resources for ICD-10

The CMS website contains all information regarding ICD-10, including where to file issues regarding the new coding.

And last but not least, No. 10: Who’s ready?

According to Cotter, most providers will have a small list of codes specific to their practices that they use just like in yesterday’s world of ICD-9. With hospitals, there is so much infrastructure that Cotter believes they are ready. Small practices could struggle more, but it’s not anticipated.

Feedback from providers to Corum at PAMED:

“The vast majority were like, ‘Come on, we’re ready,’” said Corum. “Let’s go. No more delays.”

Lenay Ruhl

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