LAS VEGAS—October 1. 2015. That’s the projected date of implementation of the ICD-10-CM.
Currently, the version used is ICD-9-CM, which is maintained by the Centers for Medicare & Medicaid Services and the National Center for Health Statistics. Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CPCO, of MJH Consulting, Denver, Colorado, asked attendees at PAINWeek 2014, “Why change” to ICD-10?
“First, the ICD-9 code set is almost 40 years old, based on the state of medical knowledge of the late 1970s, with periodic updates applied,” he said. ICD-9 “includes outdated and obsolete terminology, is inconsistent with current medical practice, and inadequately described 21st century diagnoses. This hampers the ability to compare costs and outcomes of different medical technologies, both within the US and globally, and cannot support the transition to interoperable health data exchange.”
Most importantly, ICD-9 is simply “running out of space,” Hammer said. The limited structural design of ICD-9 cannot accommodate advances in medicine and medical technology and the growing need for data. Compared with ICD-9-CM’s ~14,000 codes, ICD-10-CM has ~70,000 codes, incorporating much greater clinical detail and speci city.
Use of ICD-10-CM is required by all covered entities under the Health Insurance Portability and Accountability Act (HIPAA) and, after implementation, the ICD-9-CM code set “will not be maintained,” he said. Covered entities include physicians and other healthcare providers, health insurance companies (payers, including Medicare and Medicaid), clearinghouses, third-party billing services, and software vendors.
Hammer provided a detailed overview of the differences between ICD-9-CM and ICD-10-CM codes for many diagnoses currently encountered in pain management, including complex regional pain syndrome, pain in spinal regions, trigger points, radiculitis/ radiculopathy, spondylosis, spinal stenosis, disc displacement, disc degeneration, disc disorder with radiculopathy, osteoporosis, and sprains and strains. ICD-10-CM uses new “7th character extensions” to provide additional information about the characteristic of the encounter for episode of care for obstetrics, injuries, and external causes of injuries. For example:
- S43.422A Sprain of left rotator cuff capsule, initial encounter
- S43.422D Sprain of left rotator cuff capsule, subsequent encounter
- S43.422S Sprain of left rotator cuff capsule, sequela
He also provided a list of steps to ease the transition to ICD-10-CM:
- Educate providers about the detail required in their documentation for specific conditions and symptoms they treat
- Review and update electronic health records and procedure templates for ICD-10 documentation requirements
- Build on the ICD-9-CM to ICD-10-CM “hot list” of your most popular codes. Every month, print out a list of 10 or more diagnosis codes for each provider and try to code them. Keep a list of those that are causing questions and problems.
- For detailed information consult the 2015 ICD-10-CM website
Hammer said one myth is that “the increased number of codes will make ICD-10-CM impossible to use.” However, “just as the size of a dictionary doesn’t make it more dif cult to use, a higher number of codes doesn’t necessarily increase the complexity of the coding system. Because ICD-10-CM is much more speci c, it is more clinically accurate and uses a more logical structure, making it much easier to use than ICD-9-CM.”