Compare commonly used codes in ICD-9 vs. ICD-10

Since we have talked and read globally about ICD-10, I thought we should turn the pages a little deeper and look at some commonly used codes and see what they will look like October 1, 2013, when the new ICD-10 coding system takes effect. I selected codes for essential hypertension and elevated blood pressure reading.

There are some significant changes. The terms “benign, malignant, and unspecified” will no longer be used in defining the code selection. Also, another big change is that it appears the hypertension table is not used in ICD-10.

I took the codes in the current 2009 ICD-9 Manual and compared them to the most recent ICD-10-CM codes available. I created a table to illustrate the breakdown of this comparison.

ICD-10 guideline for urosepsis illustrates need for specific documentation

One of the most poorly documented and miscoded diagnosis is when a physician documents the term “urosepsis.” Does the physician mean that the patient has a systemic infection originating from a urinary origin, or does the patient simply have a urinary tract infection (UTI)? Currently, the default ICD-9-CM code for a UTI  is 599.0.

I had mixed feelings when I saw the following guideline in the ICD-10 Official Guidelines for Coding and Reporting (2009 version) for urosepsis:

(ii) Urosepsis
The term urosepsis is a nonspecific term. It is not to be considered synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term, he/she must be queried for clarification.

The ICD-10-CM alphabetic index states:

Urosepsis – code to condition

On one hand, it will prevent (or hopefully prevent) coders from assigning a diagnosis for sepsis when the patient has only a UTI. But on the other hand, I think this will only lead to more physician queries because it is fairly common for physicians to use this term.

The implementation of ICD-10 will inherently bring with it the need for more specific documentation. With that increased need for specificity, physicians must revise their documentation for conditions such as urosepsis.

Monitor CMS’ ICD-10 Q&As

With all the complexities related to the implementation of ICD-10, it’s no wonder that so many in the healthcare industry have a number of questions related to the various aspects of this new coding system. While the list of questions and answers posted on this CMS Web page is not as extensive as you might hope, CMS has addressed a number of common queries and provided helpful links within the posts. Consider the following Q&A:

QUESTION: Are there any instances when there is no translation between an International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code and an International Classification of Diseases, 10th Edition (ICD-10) code? How do the General Equivalency Mappings handle this situation?

ANSWER: Yes, there are instances where there is not a translation between an ICD-9-CM code and an ICD-10 code. When there is no plausible translation from a code in one system to any code in the other system, the “No Map” flag indicates this. For example, the following codes are marked with the “No Map” flag:

• ICD-10-CM code Y71.3 – Surgical instruments, materials and cardiovascular devices (including sutures) associated with adverse incidents, which 
• ICD-9-CM procedure code 89.8 – Autopsy, which has no reasonable translation in ICD-10-Procedure Coding System.

For more information on this subject, see page 16 of the publication titled Procedure Code Set General Equivalence Mappings ICD-10-PCS to ICD-9-CM and ICD-9-CM to ICD-10-PCS 2009 Version Documentation and User’s Guide. The User’s Guide is posted in the Downloads Section within the file labeled “2009 Mapping – ICD-10-PCS to ICD-9-CM and ICD-9-CM to ICD-10-PCS; and User Guide, Reimbursement Guide, Diagnosis, and Procedures.”

On May 19, CMS hosted a conference call during which it addressed in further detail the use of General Equivalence Mappings (GEMs). The CMS representative said they had about 6,000 registrants for the call, so it looks like many of you are in planning mode, which is great news! A transcript of the call will be available on the CMS Web site soon.

Alleviate fears with ICD-10 fact sheet

Discussions are starting regarding ICD-10, and there are many rumblings in the coding community. Just like anything else, something new and different can bring on feelings of being overwhelmed. Yes, ICD-10 does have a different look and feel, but it is not as challenging as many may believe. Many people have expressed to me their fears about this new coding system, conveying that they have heard how difficult it will be to use ICD-10. I am posting an ICD-10 fact sheet CMS published that will hopefully alleviate some fears and end some of the myths generated in the coding community.

Some AHIMA training sessions already sold out

The American Health Information Management Association (AHIMA) is hosting three sessions of the “Academy for ICD-10-CM/PCS Trainers”:

• July 24 – 26, 2009 | Las Vegas, NV | Planet Hollywood Resort SOLD OUT
• September 9-11 | Chicago, IL | AHIMA National Office SOLD OUT (1st session); but AHIMA added a 2nd session
• October 8-10 | Grapevine, TX | In conjunction with the AHIMA Convention and Exhibit

I was already planning to attend the national AHIMA convention October 3-8th and thought it would be a great time to attend the “train the trainer” sessions following the convention. Why make two separate trips right? Well, I had no idea that getting a seat in one of these sessions would be such an ordeal. I was concerned about registering for the October session after seeing how the first two locations were already sold out and they were more than two months away!

So, I called the AHIMA to inquire about the number of seats they had in these sessions because they seemed to go like hotcakes. The very nice representative e-mailed me and explained that they were only allowing 50 people per session (at the time) and that registration would not be available until May 1.

I marked my calendar to make sure I registered on May 1, when the registration opened. I felt like I was a teenager waiting for the hottest concert tickets to go on sale at 8 a.m. (minus the sleeping outside in the cold – not that I have ever done that anyway!)

I logged on at 8:30 a.m. EST, and registration still wasn’t available. Of course, I now remembered that the AHIMA is in Chicago, which means they are on CT. I logged back in at 9:30 a.m. EST and was able to register. Whew! I got a seat! I was so excited.

I did notice that they have now increased the maximum number to 100 attendees.

I sure hope this training is as valuable as I expect. The price is $1,900! The AHIMA doesn’t mess around being that this education will bring in approximately $190,000 per session. I am glad it is a nonprofit organization.

I am not sure whether the reason it is such a hot commodity right now is based on the fact that attendees are being proactive to get their organization ready or whether it is because there is going to be a band wagon of people “putting out shingles” that they are AHIMA certified ICD-10-CM/PCS trainers. I know that I intend on using the knowledge to share with the thousands of students who have come to rely on HCPro for their training.

Check out this sample superbill

You will need to make significant changes to your superbill due to the fact that ICD-10-CM contains a considerably larger number of codes than ICD-9-CM. 

At the American Academy of Professional Coders national conference in Las Vegas in April, Deborah Grider, CPC, CPC-H, CPC-P, CPC-I, CEMC, said,

“The one page superbill will become a thing of the past, and a 10-page superbill will be impractical for most practices. The solution may be the development of an electronic code selection tool, important for both paper-based practices and those with electronic health records.”

The American Health Information Management Association (AHIMA) converted this sample superbill to ICD-10-CM solely as an exercise to demonstrate the process of transitioning to the new coding system. It does not represent an endorsement by AHIMA of the use of superbills or of this particular superbill format.

Revamp and redesign your IT system

At the American Academy of Professional Coders national conference in Las Vegas, the ICD-10 sessions were buzzing as the HIM/coding community sounded out about the impact ICD-10 will have on information technology (IT) systems.

One session attendee described the IT implications as “Y2K on steroids.” Another person at a separate session said, “This is going to make Y2K look like a blip on the radar.”

Deborah Grider, CPC, CPC-H, CPC-P, CPC-I, CEMC, gave a presentation titled, “ICD-10-CM: The Time To Begin Preparation is NOW,” and in that session, Grider provided the following tips:

• Vendors should plan for at least 12 months of testing prior to the October 1, 2013 implementation date.
• Your IT team will need to ensure that ICD-9 and ICD-10 can work in tandem for the months prior to and the months after ICD-10 takes effect.
• Make sure that the 5010 electronic code sets are in place at your facility. You must implement the 5010 code set by January 1, 2012.
• A typical provider group of three or more physicians might spend $2,000 – $8,000 for the IT conversion or system upgrade.
• Dual systems (ICD-9 and ICD-10) create space constraints for data storage
  

AHIMA will require CEUs to reflect ICD-10 proficiency

Currenty, the American Health Information Management Association’s (AHIMA) Council on Certification (COC) has made the following recommendations regarding how credentialed members (and certified nonmembers) would demonstrate proficiency in ICD-10.

• CEUs on ICD-10 will be required per credential. The COC has not yet determined the number of required CEUs per credential.
• These ICD-10 CEUs will be in addition to mandatory CEUs reported during a 2 year cycle.
• Credentialed members will need to report CEUs by October 1, 2013. 

AAPC will require ICD-10 proficiency exam

At the American Academy of Professional Coders conference in Las Vegas, a wave of ICD-10 info (and emotion) washed over the conference attendees. Reed Pew, the AAPC CEO and president, made one announcement during his conference address on April 6 that caught the attention of many.

The AAPC will require all those with a certified professional coder (CPC) credential to take an ICD-10 proficiency exam to keep their certification. Even though this was met with a number of groans from the crowd, the AAPC is quick to stress the facts about the test:

• The test will be open book
• The test will be online
• It will consist of 75 questions
• It will cost about $60
• Coders will have  two years to take the test, starting October 1, 2012

“We want to make sure we’re the best in the industry,” said Deb Grider, CPC, CPC-H, CPC-I, CPC-P, CEMC, COBGC, CCS-P, president of Deborah Grider and Associates in Indianapolis, IN, and the former president of the American Academy of Professional Coders National Advisory Board.

What is your reaction? Do you think this proficiency exam will help to ensure your coding department is prepared for the transition to ICD-10? Let us know what you think!

Is the visit an initial or subsequent encounter?

Ready for another little ICD-10 nugget? Coders will have to learn a number of different coding conventions for ICD-10. For example, for injury code assignment, coders will need to specify whether a visit is an initial encounter.

The following is an excerpt from a recent JustCoding.com article titled, “Now is the time to start planning your roadmap to ICD-10.”

“Documentation is going to be a big issue in order for a coder to code. Laterality is a key area now that we’ll have new codes to denote right, left, and bilateral,” says Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CEMC, COBGC, CCS-P, president of Deborah Grider and Associates in Indianapolis, IN, and the former president of the American Academy of Professional Coders National Advisory Board. “Also for injury code assignment, coders will need to determine whether this visit was the initial, subsequent, or sequela.”

Under ICD-9-CM, it doesn’t matter whether the visit was an initial encounter. However, under ICD-10, it will be important to identify this piece of information using one of the following seventh characters:

• A: Initial encounter, meaning the physician is actively treating the patient for the injury (e.g., code M84.322A, stress fracture, left humerus)
• D: Subsequent encounter, meaning the patient has received active treatment for the injury, and the physician is providing routine care for the injury during the healing or recovery phase (e.g., code T50.B96D, under dosing of other viral vaccines, subsequent encounter)
• S: Sequela, meaning complications or conditions that arise as a direct result of an injury, such as scar formation after a burn (e.g., S65.009S, unspecified injury of ulnar artery at wrist and hand level of unspecified arm)

This extension will help determine whether this was the first time the patient received treatment for the injury or whether this was a subsequent visit for routine care, Grider says.