ICD-10 Is Coming: Are You Ready for the Transition?

Friday, September 6, 2013
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The clock is ticking. It is just a little over a year away until the switch to ICD-10. If you are not already preparing for the fall 2014, implementation, you should be. ICD-9 codes will be replaced, after more than 30 years, with ICD-10 codes. The mandatory implementation date is October 1, 2014. This switch applies to all Health Insurance Portability Accountability Act (HIPAA) compliant health care providers.

The ICD-10 provides much more specific data codes than the ICD-9. The added detail embodied in ICD-10 codes informs health care providers, health plans and third-party payers of patient incidence and history. This improves the effectiveness of case management and care coordination functions. Accurate coding also reduces the volume of claims rejected due to ambiguity.

This blog is intended to give health care professionals and providers an overview of ICD-10, a look at the upcoming fraud and abuse issues, and some insight into training staff.

To learn the latest ICD-10 news and access more resources, visit the CMS website at www.CMS.gov/ICD10.

What Are Some of the Differences Between ICD-9 and ICD-10?

ICD-10 is an alphanumerical system that will be converting 17,000 different disease classifications (in ICD-9) to 140,000 codes (in ICD-10). ICD-10 codes are longer (usually seven characters), which expands the number of codes that are available for use. This also provides greater specificity to identify disease analysis and severity. Unlike ICD-9 codes, ICD-10 diagnosis codes will identify the side of the body or specific organ involved. The code will also identify whether it is an initial encounter or a subsequent encounter, as well as other clinical information.

Implementation to ICD-10 consists of two parts: ICD-10-CM and ICD-10-PCS.

ICD-10-CM is for diagnosis coding and is used in all health care settings. Diagnosis coding under ICD-10-CM uses three to seven digits instead of three to five digits used with ICD-9-CM. The format of the code sets is similar.

ICD-10-PCS is for inpatient procedure coding and is used in inpatient hospital settings only. ICD-10-PCS uses seven alphanumeric digits instead of three or four numeric digits used under ICD-9. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9 coding.

Transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and inpatient procedures.

When to Implement ICD-10 Into Your Practice.

Keep in mind that the Centers for Medicare and Medicaid Services (CMS) and other payers will not be able to process claims using ICD-10 until the October 1, 2014, compliance date. Claims for all health care services and hospital inpatient procedures performed on or after October 1, 2014, must use ICD-10 diagnosis and inpatient procedure codes. After October 1, 2014, claims that do not use ICD-10 codes will not be processed.

Fraud and Audits from the Transition to ICD-10.

The switch from ICD-9 to ICD-10 will impact health care professionals, providers, billers, health plans, and anyone who analyzes health care claims data. ICD-10 coding is supposed to streamline the billing process. This will allow for more precise methods of detecting fraud.

With the coming conversion to ICD-10 coding there will likely be a surge of fraud and misrepresentation to ensue from that confusing and daunting task of switching. If physicians and health care providers code diagnosis incorrectly, the subsequent treatment can be subject to review. It’s also imperative providers learn and document ICD-10 codes correctly in order to receive proper reimbursements.

Training for ICD-10 Should Start Now.

The CMS recommends that hospitals, skilled nursing facilities, physicians’ offices and other organizations under HIPAA should start education and preparation for the ICD-10 transition now. ICD-10 plans for providers may include developing an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline and a budget. It’s recommended providers check with their billing service or practice management software vendor about their compliance plans. Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT and finance staff coordination into ICD-10.

Everyone covered by HIPAA must be ICD-10 compliant starting October 1, 2014. For more information, visit www.CMS.gov/ICD10.

Contact Health Law Attorneys Experienced in the Representation of Health Professionals and Providers.
The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, pain management doctors, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Are you familiar with the switch from ICD-9 to ICD-10? How do you think it will affect your practice? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Tag Words: ICD-10, What is ICD-10, when is the ICD-10 mandate, how to prepare for ICD-10, ICD-10 deadline, implementation of ICD-10, coding and billing, code sets, comparison of ICD09 and ICD-10, ICD-10 compliant, ICD-10 compliance, new coding guidelines, electronic health records, EHR, claim submissions, paper records, data collection, Health Insurance Portability Accountability Act (HIPAA), Centers for Medicare and Medicaid Services (CMS), The Health Law Firm

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Like this blog? Add your public comments:

Items in bold indicate required information.