by Pat Schmitter CPC, CPC-I

In approximately 24 months the most significant change to the diagnosis coding system will happen.  The Department of Health and Human Services released the final regulation in 2009 to move from the current diagnosis ICD-9 coding system to the ICD-10 coding system beginning October 1, 2013.  If your professional options do not include imminent retirement or a drastic career change, surviving the transition from ICD-9-CM to ICD-10-CM will require a strong foundation. 

ICD-10 is not just a routine annual diagnosis update.  This is a much bigger transition that requires attention devoted to physician and staff education, workflow alterations, clinical documentation, practice management operations and claims management processes and systems which must be reconfigured for ICD-10.  Failure to transition to ICD-10 on October 1, 2013 will result in delayed or denied reimbursement.  Reconfiguring your systems to be ready for implementation is required January 1, 2012 with the conversion to 5010.  While 5010 is a technical conversion where vendors will do most of the heavy lifting, the same is not true for ICD-10. The ICD-10 code set will require action from you and your practice.

Studies conducted by The Advisory Board ( estimate the incremental impact on net revenue for a 250 bed hospital one year following implementation to be $1.0-2.5M with a three year impact of $2.5-7.1M. The reasons for such significant loss include:

  • lack of clean mapping to the new code set
  • claim denials as a result of unfamiliarity with newly revised policies regarding medical necessity from payers
  • under-coding due to documentation specificity that was insufficient for accurate coding
  • over-coding driven by coder inexperience
  • payment errors due to IT issues

Of serious concern is the loss in productivity as coders query physicians for more information.  Successful use of ICD-10-CM begins with the physician or provider who is documenting the service.  Staff cannot pick a code if they do not have enough detail in the documentation.  It is critical that physicians engage now in education to improve current documentation habits in preparation for greater specificity requirements in ICD-10.  If you don’t start by making changes in your documentation now, you will be overwhelmed when it is time to implement the new codes.

While ICD-10-CM is similar to ICD-9-CM in that some terminology, conventions, classifications, and other features are the same, there are also many differences in terminology, categories, chapters, guidelines and code structure.  Advances in medicine and medical terminology and how we report quality data cannot be accommodated in the current ICD-9 system. 

Some of the category changes will include additional chapters in ICD-10-CM and the moving of some diseases to a different category. 

For example currently in ICD-9-CM, Chapter 3 Endocrine, Nutritional and Metabolic Diseases and Immunity (240-279) physicians would choose category 274 Gout and select one of 15 different codes to describe the encounter.   In ICD-10-CM, this chapter has been renamed and moved to Chapter 4, Endocrine, Nutritional and Metabolic Diseases (E00-E89). Gout has been removed from this category and placed in Chapter 13 Diseases of Musculoskeletal System and Connective Tissue.  In ICD-10-CM, physicians will choose from the category M10 Gout, and select a code from 162 choices.  In order to select the appropriate choice, your documentation will need to describe all of the following elements that most accurately describe the encounter:

  • anatomical area affected
  • laterality
  • idiopathic
  • lead-induced (also identify the toxic effects of lead and its compounds)
  • drug induced (also identify the drug)
  • renal impairment (also code the associated renal disease)
  • other secondary diagnoses (coding first the associated condition)
  • an additional code to identify certain diseases and/or disorders classified elsewhere

ICD-10 is so much more than coding and IT.  The transition to ICD-10 will have a significant impact on provider operations in almost every area.  Are you ready for ICD-10?  The time to begin preparation for transition to ICD-10 is now.

© 2011 Efficiency in Practice

Pat Schmitter, CPC, CPC-I is a Billing, Coding and Credentialing Consultant with Indianapolis Medical Management.

With almost 40 years of experience, Pat has a strong background in government payer regulations.  She provides billing and coding consulting services and is responsible for various audits; education on billing, coding and government regulations; and solvinf payor-related problems.

To reach Pat, email her at

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