Next month, the ICD-10 coding system, which will have a significant impact on all aspects of the healthcare revenue cycle, will take effect. The implementation of the new coding system on Oct. 1 comes after several delays. The system was announced in 2009 and initially scheduled to start in 2013. The system was then scheduled to take effect on Oct. 1, 2014, but was delayed by Congress as part of a bill that also pushed back Medicare reimbursement cuts.
Now healthcare providers are in the home stretch of preparing for the system, which brings a higher level of specificity to the codes used to report medical diagnoses and inpatient procedures. All HIPAA-covered entities are required to make the transition and use the codes for billing Medicare or Medicaid. Private payers are also expected to require use of ICD-10.
The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. According to Centers for Medicare and Medicaid Services (CMS), diagnosis and billing medical codes in the U.S. have not been updated in more than 35 years and contain outdated, obsolete terms. ICD-10 uses 68,000 codes compared to 13,000 available in ICD-9; however, providers do not need to use all of the codes. This new system will allow for more specific diagnoses and more flexibility if new codes need to be added.
ICD-10 will bring the U.S. up to speed with other industrialized countries, virtually all of which currently use the coding system. During the last several years, providers, payers and other leaders working in the healthcare revenue cycle have completed a coordinated effort to prepare for ICD-10.
CMS has coordinated end-to-end testing of the codes among Medicare Fee-for-Service healthcare providers, clearinghouses and billing agencies, with overall success in the acceptance of test claims. The acceptance rate during testing in April (88 percent) was higher than in January, with an increase in test claims submitted and a decrease in the percentage of errors related to both ICD-9 and ICD-10 diagnosis codes, according to CMS.
In response to requests from the provider community, CMS announced the release of additional guidance on new ICD-10 codes for medical diagnoses and inpatient procedures. It also made changes to prevent some claim denials during the first year the system is in place. “Many physicians have been concerned about adopting this code set because of the heavy investment of time and resources and the potential for claims disruptions that could interfere with patient care,” said American Medical Association (AMA) President Steven Stack.
CMS and AMA are also providing additional resources and guidance to help providers make sure they are prepared for the new ICD-10 codes. The guidance will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set, according to a CMS news release. Together with the AMA, CMS will provide educational resources including webinars, on-site training, articles and national provider calls to help physicians and other healthcare providers learn about the updated codes and prepare for the transition.
“As we work to modernize our nation’s healthcare infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics,” said CMS Acting Administrator Andy Slavitt in a news release. “With easy-to-use tools, a new ICD-10 ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”
CMS will also offer ongoing Medicare acknowledgment testing for providers through Sept. 30 and additional in-person training for small physician practices. “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs,” Stack said.
CMS also has a Road to 10 website directed at smaller physician practices and provider training videos that offer helpful ICD-10 implementation tips.