This document discusses the upcoming transition from ICD-9 to ICD-10 medical coding standards, which will take effect on October 1, 2015. ICD-10 will replace ICD-9 and features over 69,000 codes, compared to around 14,000 in ICD-9. The transition affects all healthcare providers covered by HIPAA. After October 1st, claims will no longer be paid if submitted using the old ICD-9 codes. The document outlines steps practices should take to prepare, including appointing a transition coordinator, establishing a transition plan, training staff on ICD-10, communicating with vendors and insurers, and testing systems before the deadline. Failure to transition properly could result in claim

1. WI L L Y O UR P R A C T I C E B E R E A D Y ?
THE CLOCK IS TICKING ON
THE TRANSITION TO ICD-10

2. IS THIS YOU?

3. WHAT IS THIS?
ICD-9
• International Classification of
Disease, 9th Revision.
• A list of 14,000 numerical
codes used for a specific
diagnosis.
• In use for 30 yrs.
• Inadequate for further
expansion of current medical
science.

4. ICD-10
ICD-10
• An entire new coding system with
69,000 codes.
• The number of new codes for any
physician depends upon their
specialty
• i.e. Orthopedics – 747 to
17,099!
• 13 codes for different injuries
cause by spacecraft

5. ICD-9 : ICD-10
TWO COMPLETELY DIFFERENT CODING
“LANGUAGES”

6. ICD-9 COMPARED TO ICD-10

7. OCTOBER 1, 2015
• No further delay….that is the date of transition
• Affects EVERY healthcare provider covered by the
Health Insurance portability and Accountability Act
(HIPAA) in the USA.
• Even those medical practices that are CASH ONLY

8. WHY IS THIS A BIG DEAL?
BECAUSE NO CLAIM WILL BE PAID IF IT DOES NOT USE THE
PROPER CODING SYSTEM.
• BEFORE Oct 1 - All claims for services and facility discharges
will be processed using ICD-9
• AFTER Oct 1 - All claims for services and facility discharges will
be processed using ICD-10.
• This means that for a time after October 1, physicians, staff and
billing personnel will be required to work within both coding
systems as they submit claims.

9. GENERAL EQUIVALENCY MAPPING (GEMS) = “TRANSLATOR”

10. TRANSLATING BETWEEN “LANGUAGES”
English (ICD-9)
“House”
Spanish (ICD-10)
“Casa”

11. TRANSLATION IS NOT ALWAYS 1:1
English (ICD-9)
“The”
Spanish (ICD-10)
“EL”
El Hombre
“LA”
La Mujer

12. MULTIPLE CHOICES TO MORE SPECIFICALLY
DESCRIBE THE PATIENT’S CONDITION
ICD-9
• 707.14
• “ulcer of lower limb, heel
or mid-foot”
ICD-10
• L97.401 – L97.429
• I70.234 - I70.744
• “ulcer of lower limb, heel
or mid-foot”
• Laterality (L vs. R)?
• Skin breakdown?
• Fat exposed?
• Muscle breakdown?

13. PHYSICIANS WILL NEED TO DOCUMENT IN MORE DETAIL

14. ICD VS. CPT
• ICD = International Classification of Disease (diagnosis)
• i.e. “bronchitis”
• CPT = Current Procedural Terminology (treatment)
• i.e. = Antibiotic prescription
• The only coding changes for PROCEDURES will be for those that
are in a facility (hospital, surgery center, etc)

15. PREPARING FOR THE TRANSITION
1. Appoint a Transition
Coordinator (or team)
• Responsible for all aspects
of the transition
• Should be allotted the time
to attend to all the details.
• Communicate plan and
timeline to all
office/professional staff
• Convey the importance of
this change in providing
patient care

16. PREPARING FOR THE TRANSITION
2. Establish a Plan
• Refer to CMS timelines
• Identify tasks to be
completed and in what
order.
• Assign start and
completion dates for each
task
• Create a budget
• Learn the required
resources (i.e. GEM)

17. PREPARING FOR THE TRANSITION
3. List Every Place Codes are Used
• Coding manuals
• Medical records
• Superbills
• Practice Management and Billing Systems
• Physician Orders
• Authorizations/pre-certifications
• Locations Outside the Primary Practice Site

18. PREPARING FOR THE TRANSITION
4. Authorize a
Budget
• Software upgrades
• Licensing costs
• Hardware procurement
• Staff training
• Revision of forms
• Work flow changes

19. PREPARING FOR THE TRANSITION
5. Begin Training
• Obtain ICD-10 coding books
early in 2014
• Look up/translate most
commonly used ICD-9 codes
• Begin “double-coding” as many
patient encounters as possible
(i.e. document both in “English”
and “Spanish”)
• Many EMRs are already loaded
with both sets of codes (like
EMRx!). If so, review those
codes with every patient
encounter.

20. PREPARING FOR THE TRANSITION
• Begin 6-9 months
before transition date.
• Many online sources
for training
• Certified coders may
see many ICD-10
coding modules
integrated into the
CEUs they must take to
maintain certification

21. PREPARING FOR THE TRANSITION
Communicate Early with
Vendors!
EMR/Practice Management
System
• Is the practice’s EMR ready
with the ICD-10 codes? If
not, when they will be?
• What costs are involved?
• How much tech support will
they provide?
• How will those updates be
installed into the system?
(cloud-based vs. server-
based)

22. PREPARING FOR THE TRANSITION
Communicate with Vendors
• Clearinghouses
• Coding services
• Billing services
• If their software is not up to date,
they cannot process claims!

23. PREPARING FOR THE TRANSITION
• All affiliated practice
locations – hospitals,
ASCs
• All referral medical
facilities – labs,
radiology

24. PREPARING FOR THE TRANSITION
• Communicate with the Insurance Companies!
• Rules for coverage
• Rules for authorization
• They will expect office personnel to be “bi-lingual”

25. PREPARING FOR THE TRANSITION
• Set up a Testing Schedule with all parties involved (office
staff, coders, billers, clearinghouses, insurance
companies) long before October 1st
• You want to assure the entire system from front to back
end works smoothly so there are no rejections of claims!

26. PREPARING FOR THE TRANSITION
• Submit pre-October
1st claims ASAP to
keep them from
getting caught up in
the deluge of glitches
that will likely occur
after that date.

27. PREPARING FOR THE TRANSITION
Emergency Fund
• Cash Reserves
• Lines of Credit
• Smoothes practice
management during
possible delays in
reimbursement.