Healthcare coding is having a bit of a cast change: ICD-9 is out and ICD-10 is taking over. By now, you’ve heard all about the new code set—but do you really have all the facts? In this special blog post, I’ll be busting some common ICD-10 misconceptions. (Sadly, my myth-busting measures don’t involve swimming in syrup, experimenting with explosives, or blowing up boats—we’ll leave that to the experts.) Let’s get to it!
1. The World Health Organization (WHO) created ICD-10 without clinical input.
Nope. In fact, as Sue Bowman, senior director for coding, policy, and compliance at the American Health Information Management Association (AHIMA), told Greenway Health, “From the beginning, all of the content of it really came from the clinical community.” In a June 2015 publication, the Centers for Medicare and Medicaid Services also confirmed that “the development of ICD-10-CM/PCS involved significant clinical input” and that “a number of medical specialty societies contributed to the development of the coding systems.”
2. Using ICD-10 will be Mission: Impossible.
The sheer volume of ICD-10 codes can seem overwhelming, but that doesn’t make the code set impossible to use. As CMS explains here, “Just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD-10-CM/PCS doesn’t necessarily make it more complex to use.” Those extra 55,000 codes give you the opportunity to code more logically and dig deeper into patient outcomes. Plus, you’ll still have the Alphabetic Index and electronic coding tools—like this one—at your disposal. And before you start thinking about using an ICD-10 crosswalk, take a look at some of the reasons you should avoid them altogether.
3. ICD-10 is already outdated.
Unlike the mullet, ICD-10 is still in style—and will be for years to come. ICD-10 was released way back in 1994, but it’s been consistently updated ever since. (Over the last few years, the WHO has made only limited code updates to account for new technologies and new diseases, but regular ICD-10 updates will resume in 2016. ICD-9, however, won’t be maintained at all.) So, even as the WHO works hard to refine ICD-11 for its expected 2017 implementation, ICD-10 continues to be relevant. Plus, the AMA has made it clear that it strongly opposes jumping from ICD-9 to ICD-11. You wouldn’t skip Algebra and head straight to Honors Calculus, would you?
4. ICD-10 will crush clinic productivity and cash flow.
A lot of folks are in panic mode right now, and really, there’s no reason for them to freak out. Here’s the deal: If you prepare for it, ICD-10 will not blow up your practice. While the adjustment to ICD-10 won’t happen in a flash, it’s not going to take forever—and it certainly won’t tank your productivity or revenue forever, either. According to this ICD10 Monitor article, “AAPC studies show that productivity returns to normal following 40-80 hours of work with the new code set, not years.” Moreover, this Power Your Practice post confirms that any decline in reimbursements should be just as temporary—so long as you’ve ensured your vendors and payers are ready for the switch. Even better news? That same post indicates that “once your coders and payers gain their footing, ICD-10’s specificity may actually lead to higher reimbursements for your practice.”
5. Unless you document with extreme specificity, you won’t get paid.
CMS is pretty clear about this one: “As demonstrated by the American Hospital Association/ American Health Information Management Association field testing study, much of the detail contained in ICD-10-CM is already in medical record documentation, but is not currently needed for ICD-9-CM coding.” Just like with ICD-9, billing using ICD-10 will be based on your detailed patient documentation—it’s just that now, you’ll actually code to the same level of specificity contained in your documentation. Plus, ICD-10 contains some nonspecific codes for when your “documentation doesn’t support a higher level of specificity.”
6. GEMs will solve all your ICD-10 coding problems.
As we explained here, the clustered structure of GEMs—or general equivalence mappings—means that they may map one ICD-9 code to several different ICD-10 codes, and vice-versa. So, trying to use them like single-code translation dictionaries is like trying to drive a vehicle with square wheels: you aren’t going to get very far (and the ride will be pretty bumpy). You can use GEMs to help you convert databases from ICD-9 to ICD-10—but for patient documentation? Fuggedaboutit.
7. You’ll be saved by the Congressional bell.
ICD-10 isn’t an experiment, and you must try it at home—er, the clinic. With under nine weeks to go, the chances of Congress yet again pushing back the October 1 implementation date are slim—especially because they’ll only have a few short weeks to put any type of legislation together when they come back from summer recess in September. While this myth can’t be totally busted, it’s far from plausible. Simply put, you can’t pretend like ICD-10 isn’t happening.
Now that you know the truth about ICD-10, it’s time to prepare for it. Otherwise, you and your practice will be in for a rude awakening when your claims start coming back denied. Will the transition to ICD-10 have you feeling like this? Probably not—but October 1 doesn’t have to be a terrible, horrible, no good, very bad day. Check out our ICD-10 resources to help your practice make a smoother transition to ICD-10.