Coding Central
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Inside Track to ICD-10
HHS announces delay of ICD-10 until October 1, 2014
On April 9, 2012, HHS announced its intent to delay the implementation of International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10) until October 1, 2014, from the original implementation date of October 1, 2013.
As indicated in the proposed rule, HHS believes this one-year delay “will give covered entities the additional time needed to synchronize system and business process preparation and changeover to the updated medical data code sets.”
HHS goes on to state, “By delaying the compliance date of ICD-10 from October 1, 2013, to October 1, 2014, we would be allowing more time for covered entities to prepare for the transition to ICD-10 and to conduct thorough testing. By allowing more time to prepare, covered entities may be able to avoid costly obstacles that would otherwise emerge while in production.”
As noted in the proposed rule, which has a 30-day comment period, HHS “believe(s) a one-year delay in compliance with ICD-10-CM and ICD-10-PCS achieves a balance between the needs of those who have already taken the initiative to plan for on-time compliance with ICD-10 and the need for small providers and small hospitals to have additional time to become ICD-10 compliant. While not without additional costs, a one-year delay to October 1, 2014, represents what we consider to be a reasonable compromise.”
Optum is prepared to meet the October 1, 2014, deadline. We advise our customers to remain HIPAA compliant by continuing to submit claims using current ICD-9-CM coding resources until the compliance date of October 1, 2014, and to continue to aggressively prepare for the new ICD-10 implementation date by fully assessing the impact of ICD-10, working with software and systems vendors to ensure all systems are fully compliant, and engaging in staff training well in advance to help mitigate any loss of productivity or revenue.
To access the full proposed rule go to:
Other noteworthy items within the April 9, 2012, proposed ruling include adoption of a unique health plan identifier (HPID) and a data element that would serve as an “other entity” identifier (OEID), as well as the addition of a National Provider Identifier (NPI) requirement.
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Even with an extra year to prepare, it is imperative to stay the course in order to be ready.
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To begin our preparation for change, let's address some of the most frequently asked questions that coders ask regarding ICD-10-CM and the guidelines. Click Here
Q: What are the similarities and differences between ICD-9-CM and this new system?
A: Below is a side by side comparison of some of the differences and similarities between the two classification systems:
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ICD-9-CM
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ICD-10-CM
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3-5 digits- numeric |
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3-7 digits; alphanumeric, not case sensitive |
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17 Chapters - body system based - same order |
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21 Chapters - body system based - same order |
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Supplemental chapters E and V codes - alphanumeric codes |
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No supplemental chapters |
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General conventions |
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General conventions |
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Official coding guidelines |
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Official coding guidelines |
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Chapter specific coding guidelines |
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Chapter specific coding guidelines |
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Index and Tabular sections |
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Index and Tabular sections |
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Neoplasm Table and Table of Drugs as part of the Index to Disease |
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Index- two sections Index to Disease and Injury |
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Tabular List has Categories ( 3 digit), subcategories (4 digit) , subclassification codes( 5 digit) |
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Neoplasm Table and Table of Drugs as part of the Index to Disease |
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No placeholder |
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Tabular List has categories ( 3 digit), subcategories (4, 5 or 6 digits), Extensions (7th character) |
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Punctuation [ ] ( ) : } [ ] |
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Placeholders ('x') (5th character) for future expansion |
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Other specified (NEC) and unspecified (NOS) codes |
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Punctuation - No braces, No slanted brackets |
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"And" means "and/or" |
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Other specified (NEC) and unspecified (NOS) codes |
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Includes notes and Includes terms |
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"And" means "and/or" |
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Excludes note |
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Includes notes and Includes terms |
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Manifestation/etiology convention "in conditions classified elsewhere" |
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Excludes notes- two types Excludes 1 (Not coded here) and Excludes 2 (Not included here) |
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"Code first", "Use additional code", and "Code also" notes |
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Manifestation/etiology convention "in conditions classified elsewhere" |
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Index notations:
- See
- See also
- See condition
- Morphology codes (M codes)
- Indent structure
- Main term - condition
- Omit code
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"Code first", "Use additional code", and "Code also" notes |
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Index notations:
- See
- See also
- See condition
- Morphology codes (M codes)- omitted
- Indent structure
- Main term - condition
- Antiquated terms are gone
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Q: What are the most significant benefits of ICD-10-CM?
A: Some, and only some, of the benefits associated with the new classification system are:
1. Consistent terminology
2. Flexibility to expand
3. Detail/Specificity
a. Clinical specificity and encounter history
b. Ability to report bilateral sites or separate encounters
c. More clinical information included, less risk of losing information
d. Capture of trimester data
4. Consistent coding direction
5. More combination codes to capture both manifestations and underlying disease with a single code.
Q: What can be found regarding the coding and reporting guidelines for ICD-10-CM?
A: The NationalCenter for Health Statistics (NCHS), the Federal agency responsible for the use and development of ICD-10-CM in the United States, has posted detailed information regarding the current guidelines, the current draft code set and mapping files on their website. The guidelines for proper use of ICD-10-CM are the result of the efforts of four groups: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Medicare and Medicaid Services (CMS) and NCHS. As mandated by the Health Insurance Portability and Accountability Act, this set of guidelines provides coding and sequencing direction with additional instruction on the conventions used in the classification system.
Q: How do these guidelines directly affect the coding staff?
A: The governing bodies responsible for the developed these guidelines have given careful consideration to providing clear instruction regarding the use of the classification system to ensure consistent usage of the code set. Consistency in code assignment results in more the accurate identification the diagnoses and procedures that are reported. It continues to be important to consider the relationship between documentation and coding accuracy. Given the increased specificity and updated clinical concepts inherent in the new classification system, a good implementation plan will address the specific documentation needs for a facility or specialty practice based upon those conditions most frequently reported by that facility. Focused training of staff and improved documentation practices on specific issues rather than taking a broad approach is a more efficient process.
The current draft guidelines can be reviewed on the NCHS website:
http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
Q: How often does NCHS make changes to the draft code set and guidelines?
A: The current update schedule for the draft ICD-10-CM/PCS code set and guidelines is annual and the changes are released the end of December. Once the code set becomes effective, the update schedule will follow the current ICD-9-CM schedule October 1, and April 1. NCHS provides a summary document of the changes made to each draft edition.
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