ICD-10: The Code That Cried Wolf by Sue Kay and Mary Kustermann

Do you remember the story of the little boy who cried wolf? It goes something like this…

There once was a shepherd boy who was bored as he sat on the hillside watching the village sheep. To amuse himself he took a great breath and sang out, “Wolf! Wolf! The Wolf is chasing the sheep!”

The villagers came running up the hill to help the boy drive the wolf away. But when they arrived at the top of the hill, they found no wolf. The boy laughed at the sight of their angry faces.

“Don’t cry ‘wolf’, shepherd boy,” said the villagers, “when there’s no wolf!” They went grumbling back down the hill.

The little shepherd boy did this over and over again. One day, he saw a real wolf chasing the sheep. But when he called out to the villagers, no one came. They had been fooled too many times before.

Many of you may feel the same way about ICD-10. We’ve been hearing that ICD-10 was coming since 1992 and perhaps you have lost trust in the fact that it would actually ever happen. Rumor no more, the transition into the ICD-10 classification is fast approaching and now is the time for you to sit up, take notice and take action.

After many years if not decades of delays, ICD-10-CM will be mandated throughout the health care industry as of October 1, 2013. In January of this year, Health and Human Services also released an additional rule dealing with HIPAA 5010 transaction sets. The final rule calls for compliance by January 1, 2012. With both of these deadlines looming, practices must not delay getting prepared.

ICD-10 will consist of two parts: ICD-10-CM for outpatient diagnostic coding and ICD-10-PCS for inpatient procedure coding. ICD-10-CM will be used in all health care settings while the ICD-10-PCS will only used for inpatient hospital settings. For purposes of the rest of this article, we will focus on details as they relate to ICD-10-CM.

What are the major differences between ICD-9 and ICD-10?

  • The number of codes: There are approximately 14,300 ICD-9 diagnostic codes. With ICD-10, you’ll have more than 69,000 to choose from.
  • ICD-10-CM codes start with a letter and can be up to 7 characters.
  • ICD-10-CM offers and requires a higher level of specificity. There are fewer NOS (not otherwise specified) code options and the coding has been expanded to include right and left designations.

 And most experts agree that there are some significant advantages to ICD-10 over ICD-9 including its flexibility, its ability to be more detailed and its ability to capture advances in medicine and technology. Even the increased number of codes offers an advantage in that it’s oftentimes easier to determine the correct code to use if the list from which to choose is more specific.

The potential challenges of implementing ICD-10-CM? It’s another thing in a long list (EHR, Meaningful Use, Red Flags) that must be addressed and acted upon in the coming months.   

What should you do to prepare?

According to the CMS website, these are the things you should be doing to prepare:

Identify your current systems and work processes that use ICD-9 codes. This could include clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.

• Talk with your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes. Contact your vendor and ask what updates they are planning to your practice management system for both Version 5010 and ICD-10, and when they expect to have it ready to install. Check your contract to see if upgrades are included as part of your agreement. If you are in the process of making a practice management or related system purchase, ask if it is Version 5010 and ICD-10 ready.

• Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition. Be proactive, don’t wait. Contact your payers, clearinghouse, billing service with whom you conduct business, ask about their plans for the Version 5010 and ICD-10 compliance, and when they will be ready to test their systems for both transitions.

• Talk with your payers about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD-9 codes, payers may modify terms of contracts, payment schedules, or reimbursement.

Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, online courses, webinars, and onsite training. If you have a small practice, think about teaming up with other local providers. You might be able, for example, to provide training for a staff person from one practice, who can in turn train staff members in other practices. Coding professionals recommend that training take place approximately 6 months prior to the October 1, 2013 compliance date.

Stay Informed!

Many changes will continue to challenge practices, so start today and the impact will not be insurmountable.  Take part in the national provider teleconferences sponsored by CMS.   

The websites below will provide you with the latest information regarding the implementation of the ICD-10.   

Additional resources;

http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp#TopOfPage -look for downloadable presentations, written and audio transcripts of national provider calls

www.cms.gov/ICD10 – Tools – GEM, General Equivalency Mapping is a crosswalk tool that will allow for forward and backward mapping from ICD-9 to ICD-10 codes.

http://www.cms.gov/ElectronicBillingEDITrans/03_EDISupport.asp#TopOfPage -Free billing software for Medicare fee for service providers

www.cdc.gov/nchs/icd.htm – General ICD-10 information

www.ahima.org/icd10 – American Health Information Management Association

© 2010 Efficiency in Practice


Sue Kay, Senior Consultant at InHealth, is the editor of Efficiency in Practice, the free eNewsletter for medical practice managers who want to save time, money and reduce risk.  For more information and to access your FREE report, The 8 Things You MUST Know About CMS’ RAC Program, visit www.efficiencyinpractice.com  or check out our blog at www.efficiencyinpractice.blogspot.com.

Mary Kustermann, RMC, RMM, CPC, CPC-H is a Senior Consultant at InHealth and a certified professional coder with more than 35 years of coding and medical administrative experience.

This article can be reprinted freely online, as long as the entire article and this resource box are included.

Comments are closed.