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.
Download a complete overview of the changes and some important ICD-10 conventions to remember.
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 AUGS 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 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. The Centers for Disease Control has provided updates to ICD 10 Coding Manual, which can be viewed here.
CMS ICD-10 Crosswalks
The AUGS Coding and Reimbursement 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 members, please email firstname.lastname@example.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.
Visit 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.