The implementation of ICD-10 will dramatically impact the way coding is done.
In October 2015, the US health care system will transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). Proper attention to these codes is necessary to ensure accurate reimbursement in medical practices. ICD-10 code sets allow for greater specificity and exactness in medical diagnoses and inpatient procedures reporting. Providers will need to work more to document diagnoses as ICD-10 has 8 times more codes than ICD-9. Pediatrics, cardiology and nephrology are the medical specialties that will be more significantly impacted than others.
Specialties Facing the Most Documentation Challenges with ICD-10
- Pediatrics – According to a study published earlier this year, pediatricians will have to pay special attention to specific codes in the transition to ICD-10. The researchers studied a data set from Illinois Medicaid specified for pediatricians. More than 2,700 ICD-10 codes were identified and divided into five categories: identity, class-to-subclass, subclass-to-class, convoluted and no translation. The study found that 26 percent of the codes were classified as convoluted and represented about 21 percent of all patient encounters and 16% of reimbursement. The diagnosis codes represented by information loss (3.6%), overlapping categories (3.2%), and inconsistent (1.2%) made up 8% of Medicaid pediatric reimbursement. It was therefore concluded that such potential for financial disruption and administrative errors would require pediatric practices to pay closer attention to these codes when transitioning to ICD-10.
- Cardiology – The transition will also be particularly challenging for cardiology providers as more new cardiology-specific procedure codes are included under ICD-10. Here are some examples where miscoding can occur:
- In ICD-10, the acute phase of myocardial infarction has changed to 4 weeks from eight weeks in ICD-9
- The codes specifying the episode of care will cease to exist. For example, AMI of the anterolateral wall which is coded as 410.00 for an unspecified episode of care in ICD-9 will change to I21.09 in ICD-10, which has no relation at all to episode of care
- Atherosclerotic heart disease of native coronary artery with angina pectoris takes only a single combination code (I25.11) in ICD-10, unlike ICD-9 where it takes two separate codes
Complication codes will also be much more specific in ICD-10-CM.
- Nephrology – Nephrologists treat patients with Chronic Kidney Disorder (CKD). This disorder has only one code in ICD-9, but under ICD-10, five different codes will have to be applied correctly. Also hypertensive chronic kidney disease will take two codes – the first one will indicate both hypertension and CKD, and the second code will specify the level of CKD.
With these new challenges, diagnostic coding for these specialties will become extremely confusing, time consuming and complicated. Due to the ICD-10 transition, these specialists and others would need to pay greater attention to coding than providing care to their patients. In such a scenario, hiring the services of a expert medical billing and coding company which is ICD-10 ready could be the solution to minimizing the errors and ensuring proper reimbursement.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.