Presented By
Erline Franks CCS-P

• The United States is the only nation that has not implemented ICD-10
• ICD-10-CM set to begin October 1, 2014
• Regular updates which go into effect October 1 of each year, starting in 2015.
• ICD-10-CM consists of 21 chapters compared to 17 chapters in ICD-9-CM
• ICD-10-CM is based on statistical classifications of disease by the World Health Organization (WHO)
• Guidelines have been approved by the American Hospital
Association (AHA), American Health Information
Management Association (AHIMA), CMS, and NCHS

• The transition to ICD-10-CM is happening because ICD-9 provides limited data about the medical conditions of patients’ and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. The structure of
ICD-9 also limits the number of new codes that can be created, and many categories in
ICD-9 are full.

ICD-9-CM (Volume 1 & 2)
3-5 characters in length
Approximately 14,000 codes
First digit may be alpha (E or V) or numeric; digits 2-5 are numeric
Limited space for adding new codes
Lacks detail
Lacks laterality
ICD-10-CM
3-7 characters in length
Approximately 68,000 codes
Digit 1 is alpha (to indicate the category);
Digit 2 is numeric (in the future, alpha characters may be used if code expansion is needed);
Digits 3-7 can be alpha or numeric
Flexible for adding new codes
Very specific
Includes laterality (i.e., codes identifying right vs. left)

• ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by HIPAA
(Health Insurance Portability and Accountability
Act), not just for those who submit Medicare or
Medicaid claims.
• This change does not affect CPT coding for outpatient procedures.
• This change includes: Providers, Payers, Software vendors, Clearinghouses, and third-party billing services.

• Create a practice ICD-10 Team
• Budget for Implementation Costs
• Create a timeline (including a team leader responsible for each area)
• Identify current and future educational needs for staff
• Communicate with your Practice Management
System Vendor

• Communicate with your billing Service,
Clearinghouse, and Payers as to hardware and software concerns
• Communicate with your payers about how your contracts will be affected
• Identify changes to your Practice Work Flow and Business Processes

Identify your education needs:
• Get a copy of the ICD-10-CM code set.
• Identify your practices’ top 50 diagnosis codes currently used.
• Remove the unspecified codes. (Remember, unspecified codes may not be reimbursed with ICD-10)
• Review your documentation and determine the changes that will need to take place to support the more specific ICD-10 codes.
• Continue education on the rest of the top 50 codes

• CMS (Centers for Medicare & Medicaid Services) www.cms.gov/Medicare/Coding/ICD10/
• AHIMA (The American Health Information
Management Association) www.ahima.org/icd10/
• SS&G Healthcare, LLC www.ssandghc.com
• Specialty Specific Societies
• Software and System Vendors

• Yesterday!!!
• Health care organizations that submit transactions electronically are required to upgrade transaction standards from
4010/4010A to Version 5010 effective January,
2013

• AHIMA Checklist— www.ahima.org/downloads/pdfs/resources/c hecklist.pdf
 Phase 1: Implementation plan development and impact assessment (first quarter 2009 to second quarter 2011)
 Phase 2: Implementation preparation (first quarter 2011 to second quarter 2013)

 Phase 3: “Go live” preparation (first quarter 2013 to third quarter 2013)
 Phase 4: Post-implementation follow-up (fourth quarter 2013 to fourth quarter 2014)
• Expect a significant reduction in productivity for the first three to six months
• Expect an impact in your cash flow

• Mappings between ICD-9-CM and ICD-10-CM classifications have been developed to transition one code set to another
• The NCHS ( National Center for Health Statistics) has released the GEMs, along with documentation and a user’s guide, are available on the NCHS website http://www.cdc.gov/nchc/icd/icd10cm.htm and the GEMs website http://www.cms.hhs/gov/ICD10)

• Appropriate Usage:
• Convert multiple databases from ICD-9-CM to
ICD-10-CM
• Variety of research applications involving data trend
• Inappropriate Usage:
• Crosswalks- There is not a one -to-one match between ICD-9-CM and ICD-10-CM codes, for a multitude of reasons (e.g. new concepts in ICD-
10-CM , a single ICD-9-CM code may map to multiple ICD-10-CM codes)