CMS ICD-10 Updates
Most providers are familiar with ICD-9 and now, ICD-10, mostly, because it is what we use to document a patient’s symptoms, conditions, or disease to facilitate billing and reimbursement for medical services rendered. ICD-10 is an international system for morbidity and mortality reporting. The structure and guidelines behind ICD-10 allows for increased levels of clinical specificity which provides more information about the quality of care received and it has the potential to improve tracking of outcomes of care. Providers must understand that they are not only coding for reimbursement, they are also facilitating the collection of statistical data and disease classifications. It must be recognized that while this level of reporting is necessary moving forward, it does not directly change or impact reimbursement. In addition, the classifications of certain conditions have changed. Please read here for a complete overview of the changes and some important ICD-10 conventions to remember.
Keep Up to Date on ICD-10 by visiting the CMS ICD-10 website for the latest news and resources to help you stay prepared. You can also watch this short MLN Connects® video on the CMS YouTube Channel, where Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) discuss the unique characteristics and features of the new coding system.
One of the significant difference between ICD-9-CM and ICD-10-CM is the need to assign a 7th character, also called a 7th character extension, to code certain categories. The 7th character in ICD-10 is used in certain categories such as Obstetrics, injury, musculoskeletal and external causes. The Coding and Reimbursement Committee has created this fact sheet on how to use the 7th character.
Another noticeable difference in ICD-10-CM within Chapter 14 Diseases of the GenitoUrinary System (N00-N99) was the creation of the category known as N99, which contains a list of codes not elsewhere classified within this chapter. Specifically, N99 contains codes that describe both postprocedural disorders, as well as Intraoperative and Postprocedural complications. This category of codes can contain up to six alphanumeric characters. This fact sheet developed by the AUGS Coding Committee explains this category that can be somewhat confusing to providers to intimately familiar with ICD-10 convention.
CMS finally transitioned to ICD-10-CM on October 1st, 2015, replacing ICD-9. In order to assist providers and payers with this implementation, CMS allowed for a 12-month transition period, during which CMS contractors are allowing practitioners to submit claims using less specific codes, as long as practitioners use a valid code from the right family. This transition period has ended on 9/30/16. Beginning on October 1, 2016, CMS will require greater specificity for claims filed in ICD-10-CM/PCS. Providers are now required to use the most specific code for the claim being filed. If a CMS audit reveals that more specific or more appropriate code should have been used, CMS will apply a financial penalty to that claim. You can read a complete overview here.
CMS ICD-10 Crosswalks
The AUGS Coding Committee has put together this useful tool to help with common Urogynecologic ICD-9 to ICD-10 crosswalks. If you have an ICD-10 code that you think would be useful to AUGS membership, please email Mitra@augs.org to add them to our Frequently Used Urogynecology Code List!
In response to questions from the health care community, CMS has released "Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities," which provides answers to the most commonly asked questions.
What is ICD-10?
The World Health Organization (WHO) maintains the International Classification of Diseases (ICD) which is the standard diagnostic tool for epidemiology, health management, and clinical purposes. ICD is used to classify morbidity and mortality for tracking vital statistics and health insurance reimbursement across the world. ICD nomenclature provides standardization of disease classification that is used worldwide. The ICD system has been in evolution for over 150 years. The ICD codes are revised and updated by WHO once every ten years to meet the advances in medical science and assure comparability of health statistics internationally. ICD-10 is the most recent standardized set of codes, and was endorsed by the Forty-third World Health Assembly in May 1990 and came into use by WHO Member States since 1994. Currently, ICD10 is considered the world standard for health and disease classification. More information on the history of ICD 10 and up-to-date implementation information is available on the WHO website: http://www.who.int/classifications/icd/en/
Why is ICD-10 Transition Required in the US?
ICD-10 is a needed change to the over 30 years old ICD-9 coding vocabulary. ICD-9 has outdated terms and limited codes to capture current practices in medical care. The ICD-9 structure limits the number of new codes that can be created.
Who is Required to Transition to ICD-10?
All HIPPA “covered entities” are required to use ICD-10 by October 1, 2015.
How is ICD-10 Different than ICD-9?
ICD-10 has over 68,000 codes, whereas ICD-9 has just over 14,000. ICD-10 has increased length of characters and a more flexible structure to allow creation of new diagnosis codes. ICD-10 has more accurate data for evaluating health care quality measures.
What is the basic structure of the new ICD-10 codes?
The basic structure of the new code is the following:
Characters 1-3 – disease category
Character 4 – etiology of disease
Character 5 – body part affected
Character 6 – severity of illness
Character 7 – placeholder for extension of the code to increase specificity
How Do We Begin to Transition Our Practice?
CMS recommends that medical practices take steps to prepare for implementation of the new code set years in advance. Not only must new software be installed and tested, but medical practices need to provide training for physicians, staff, and administrators. Practices will need to create crosswalks to convert ICD-9 to ICD-10 conversions around each encounter. Practices should check with their electronic medical record vendor to assure their encounter documentation will include the up to date standards as required by CMS.