Agency leaders know that now more than ever, coding is driving payment and is a focus of audit by RACs, MACs, and Z-PICs. It is imperative that the primary diagnosis, primary secondary diagnosis, and sequencing of all codes clearly delineate the picture of the patient and his/her condition. The codes are the Table of Contents in the home health chapter of the book known as the patient clinical record.
Agency leaders want appropriate payment and compliance. Equally important, they want to retain that payment received. At VNAA’s 30th Annual Meeting In early May, 2012 preparing for ICD-10 will be discussed in depth, but what are some of the general concepts and constructs that differ from ICD-9 CM? To prepare for this grand change, what should you do? Commit to learning about ICD-10 CM. It impacts more than just the coding department. Everyone in your agency will be impacted.
CMS is preparing. While Home Health Agencies were focusing on new CY 2011 regulations and plenty of changes last year, agency leaders were aware that there was a change to Version 5010 for handling electronic claims. CMS will still accept Version 4010 claims for a short period. This billing change was necessary in preparation for ICD-10 CM scheduled for October 1, 2013.
The ICD-9 CM Coordination and Maintenance Committee
“Recognizing the ICD-9-CM as a dynamic statistical tool that must be flexible to meet expanding classification needs, the ICD-9-CM Coordination and Maintenance Committee was created as a forum for proposals to update ICD-9-CM. A representative from the National Center for Health Statistics (NCHS) and one from the Centers for Medicare and Medicaid Services (CMS) co-chair the ICD-9-CM Coordination and Maintenance Committee meetings. Responsibility for maintenance of the ICD-9-CM is divided between the two agencies, with classification of diagnoses (volumes 1 and 2) by NCHS and of procedures (volume 3) by CMS”. (http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm).
The ICD-9-CM Coordination and Maintenance Committee’s role is advisory. The Director of NCHS and the Administrator of CMS make all final decisions. Final decisions are made after the December meeting and become effective October 1 of the following year. Official code revision packages, which are referred to as addenda, are available from this site.
The transition to ICD-10 is a major change for the industry. To better effect that transition as well as the Version 5010 to handle electronic claims, the ICD-9-CM Coordination and Maintenance Committee proposed and accepted a partial freeze. This freeze identifies:
- The last regular annual updates to ICD-9-CM and ICD-10-CM were made October 1, 2011
- Limited updates to ICD-10 CM for October 1, 2013 (ICD-10-CM is expected to be fully in use in Home Health by 2013)
- Full regular updates to ICD-10 CM to be reinstituted October 1, 2014
What is ICD-10 CM?
- ICD-10 CM is the US “Clinical Manifestations” of the World Health Organization (WHO) ICD-10 Code Set.
- ICD-10 PCS is a US creation for procedure codes only that will essentially be used in the acute care setting.
- ICD-10 CM brings the US in alignment with the worldwide coding system.
- ICD-10 CM offers greater coding specificity and accuracy.
- IVD-10 CM offers increased capability to measure healthcare quality, safety, and efficiency.
Transaction version changes (X12 version 5010) must be in place to handle the new codes and its seven digits, thus the changes for billing this year.
CMS states, ICD-10 is markedly different from ICD-9 and they expect adjustment reaction to cause slowing in payment. Many coding experts believe that, with proper planning, that need not be the case.
“ICD-10 requires changes to almost all clinical and administrative systems. It requires changes to business processes.” Per CMS
Why Must We Change to ICD-10?
- ICD-9-CM is over 30 years old.
- ICD-9 CM has no more room to add new codes or keep pace with current classification of Medical conditions or technological advances.
- ICD-9 CM is not always precise or unambiguous.
US mortality data is being reported in ICD-10 thus making comparison of mortality and morbidity difficult.
ICD- 10 CM offers:
- Lower Costs through increased efficiencies
- Synergistic effects with the Electronic Health Record (EHR)
- Clearer recognition of medical advances
- Clearer recognition of technological advances
What are some of the Differences between ICD-9-CM and ICD-10-CM?
ICD-9-CM
17 chapters and V and E code chapters
13,000 disease codes plus V and E codes
3,000 procedure codes in Volume 3
3-5 digits in disease codes
Essentially numeric system
Codes usually do not indicate timing encounters
No differentiation between left/right
ICD-10-CM
21 chapters- V and E codes in disease chapters
68,000 disease codes, including V and E codes
87,000 procedures codes in ICD-10-PCS
3-7 digits in disease codes
Alphanumeric system
Codes specify initial and subsequent encounters
Differentiates between the right and left
Solid understanding of anatomy, physiology, and diagnostics will be a must.
In May, come to the session: Start Preparing NOW for ICD-10 CM Coding and receive a plan for your coding teams’ educational preparation needs with examples of how to review anatomy, physiology, and diagnostic essentials. It may seem like ICD-10 is far away but, an additional 55,000 diagnostic codes, a change in chapters, and required increased coding specificity to the 7th digit means increased risk for payment and more importantly, increased risk for payment retention. If your payment retention becomes in question, can the MACs, RACs, or Z-PICs be far behind? Could you survive what is coming with the coding preparation you have right now?
This article was written by Susan J. Carmichael MS, RN, CHCQM, COS-C, FAIHCQ, Susan is the Executive Vice President, Chief Clinical Officer and Chief Compliance Officer for Select Data, a national firm providing Revenue Cycle Management services, software, and process solutions to the home health industry for over 20 years. Susan has held C Level positions for nonprofit, and publicly traded home health firms. She has taken agencies to both the American and NASDAQ Stock Exchanges, has grown multi-state Medicare-Medicaid/Private Duty/Staffing agencies by both acquisition and native growth, and is credited with growing one firm from billing $114.00 (first week) to $515,000 per week in less than five years. Susan’s latest publication was The Remington Report, July/August, 2010Recovery Audit Contractors (RACs): Seven Major Changes to the Permanent Program and in the September/October issue: The RAC Attack: How to Prepare and Manage the Audits. Susan is a frequent requested speaker at state association conferences on industry topics, including OASIS, Coding, RACs/MACs/MICS/Z-PIC audits, and Corporate Compliance program essentials.
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