Students and ICD-10

Oct. 1, 2013 seems like a long time away but there are many things students can do now to become ready for this massive change in healthcare. It’s too soon to learn the new code set in detail, instead, continue your focus on ICD-9 and learning that system, it won’t be wasted. Coders will still need to code ICD-9-CM after Oct. 1, 2013 and we may have to use dual systems for some time, billing and coding with both ICD-10-CM and ICD-9-CM. Workers compensation and auto claims do not fall under HIPAA mandates and may not feel the push to transition to ICD-10. For this reason proficiency in ICD-9-CM remains extremely important. You will need to be proficient in both skill sets for many years to come.

ICD-10 requires a higher level of specificity than what is found in ICD-9 and a strong foundation in anatomy and terminology is needed to successfully code in the new code set. Strengthening your foundation now is a good start to being able to use the codes in ICD-10. If you haven’t had a formal class yet, now is the time to turn your attention to that area.

The ICD-10 codes are still in draft revisions meaning if you focus on learning the codes and guidelines now you will have to relearn them over and over again until the code set is adopted. It is not suggested that students begin to learn ICD-10 until 2013.

The Centers for Medicare and Medicaid Services (CMS) issues a code set freeze, which will allow a stable learning environment effective with the 2012 codes; however, if you are not coding with these codes daily, retention will be difficult. There were several thousand code changes/revisions for both 2010 and 2011, and this could easily frustrate your learning process if done too early. Instead, wait until the right time to learn the final codes.

There are many similarities between ICD-9-CM and ICD-10-CM in the guidelines, which will help ease your transition. Some of the differences you will encounter will include:

1. Higher level of specificity. Codes go up to seven characters in length.

2. Expanded injury codes, which group codes by site of injury in ICD-10-CM instead of type of injury in ICD-9-CM.

3. Creation of diagnosis/symptom combination codes, which may actually allow for reporting of fewer codes in ICD-10-CM.

4. Alphanumeric structure using all digits and characters except the letter U. This allows for flexibility and has the space needed to add new codes as needed.

5. Laterality. In ICD-10-CM you will need to know if the condition affects the left side, right side or if it is a bilateral condition.

6. Seventh character extenders. This is a new concept for us in coding. The seventh character extender must always be the seventh character. Examples of seventh character extenders are A for active treatment; D for subsequent treatment; and S for sequela.

7. “Dummy” place holders. Because of the need for the seventh digit character extender in certain situations, the code selection may only go up to character four or five meaning we will have to use the letter “x” to fill in up to the seventh character when needed.

Let’s take a look at this example:

Patient presents to the local ED for a laceration of the ulnar artery at the forearm on his right arm.
S55.011 Laceration of ulnar artery at forearm level, right

– A-Initial encounter

– D-subsequent encounter

– S-sequela

Code selection is S55.011A

– Extension “A,” initial encounter, is used while the patient is receiving active treatment for the injury

In this example you can see where ICD-10-CM drills down to the specific site of the condition including laterality and the use of the seventh character extender.

Documentation will be a key solution in ICD-10-CM code selection success. If you have access to provider documentation or are working with a provider, showing him or her some of the changes now could help ease the transition with the performance of documentation audits. Look at existing documentation and make sure there is enough information documented in the record to assign the encounter with the seventh character extender, that laterality is well documented and that the provider is documenting with specificity on the site of the injury or details about the patient condition.

Remember that you will be key to a smooth transition for ICD-10 implementation, and careful consideration to timely learning is crucial.

Rhonda Buckholtz is vice president of business and member development at the AAPC. She has more than 20 years experience in health care, working in the reimbursement, billing and coding sector. Before joining the AAPC, she was the administrator for a five-location practice in Pennsylvania as well as being an instructor for Venango Campus, Clarion University for coding and billing.

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