By now, you probably know the basic history behind ICD-10: Many years ago, the World Health Organization grew weary of a static code set, incapable of expanding. So they updated the International Classification of Diseases, 9th revision (ICD-9) codes and replaced them with the 10th revision (ICD-10) codes to create a classification system for morbidity and mortality using greater specificity. Let’s face it, the ICD-9 code set was old, dating back to 1979 (think rotary dial telephones and stovetop popcorn), and needed a serious overhaul.
Switch to present day: For years, 99 countries have used ICD-10 codes to classify morbidity, and 138 countries have used ICD-10 codes to classify mortality. Several countries got creative and developed their own unique versions of ICD-10 codes, including Germany, which came up with the ICD-10-GM (German Modification) code set. CMS jumped on the bandwagon to create the ICD-10-CM (Clinical Modification) code set with 68,000 codes to better track and classify diseases, conditions, and injuries, compared to only 13,000 codes in ICD-9-CM. The U.S. also created the ICD-10-PCS (Procedure Coding System) codes for tracking inpatient procedures. But convincing the U.S. healthcare community that the changeover to ICD-10 is unavoidable has been a daunting task.
|461.8, Other acute sinusitis||
J01.40, Acute pansinusitis, unspecified
J01.41, Acute recurrent pansinusitis
J01.80, Other acute sinusitis
J01.81, Other acute recurrent sinusitis
Oct. 1, 2015, is still the drop-dead ICD-10 transition date from ICD-9 to ICD-10, with no more ICD-10 delays. Don’t land in hot water standing idly by waiting for more delays, even though the proposed/final implementation dates changed four times since 2011.
In the news: If you’ve been keeping tabs on legislation, you know that there are a number of bills related to ICD-10 under consideration. For instance, one House bill, HR 2247, the ICD-TEN Act, gives Medicare providers and suppliers a safe harbor period after implementation on October 1 to get up to speed on the ICD-10 code set. During an implementation period, Health and Human Services would have to conduct end-to-end testing to ensure systems correctly handle ICD-10 codes. Once testing indicates the system is fully functioning, an additional 18 months would kick in to complete the implementation period. The bill stipulates that Medicare would not be allowed to deny claims containing unspecified or inaccurate subcodes during the implementation period.
Another bill wants to create even bigger changes for ICD-10, but don’t get too excited if you’re watching HR 2126, the Cutting Costly Codes Act, which aims to once again stop ICD-10 in its tracks. The last time this bill was introduced, it fell flat. Although Steven Stack, the incoming president of the American Medical Association, supports the bill, many industry experts suspect it won’t gain enough momentum to make a difference. Delaying your implementation efforts waiting for this bill to pass means you may be throwing your future revenue right out the window.
Review software/systems and formulate a plan: Take a look at all of the software and systems that will house ICD-10 codes and interface with each other to transmit claim data to payers:
ICD-10 is literally right around the corner and won’t be delayed again. You may have heard the frightening statistics: Over 50 percent of providers are still waiting for another delay so they haven’t even started planning, let alone begun ICD-10 training. Don’t risk losing thousands in revenue by being caught off guard when ICD-10 hits. With less than six months to go, you need to get ready now before it’s too late.