ICD-10-CM is coming on like a freight train. If you are in the medical profession and you don’t know what ICD-10-CM is, you must have been in a coma for the last few years.
ICD-10-CM is a long overdue update to the ICD-9-CM diagnosis code set that was introduced over 25 years ago. Where ICD-9-CM had about 9,000 codes, ICD-10-CM has nearly 70,000 – an almost 10 fold increase. Many ICD-10-CM codes are much more specific than their ICD-9-CM counterparts.
And if you are thinking that ICD-10-CM only affects the coders and billers – watch out! It will have a huge effect on how providers document patient encounters. Because of the requirement for higher specificity with ICD-10-CM, providers will need to ensure that their documentation includes the specifics needed for the coders and billers to arrive at a highest specificity ICD-10-CM code.
Although there are still many “unspecified” codes in the ICD-10-CM code set, many payers, including Medicare, have indicated that they may pay less for claims that use those unspecified codes – and may just deny those claims, or return them asking for more documentation.
Medicare has recently announced a “grace period,” wherein they will not penalize or deny claims if the ICD-10-CM code is “in the same family” as the correct code, but all people in the claims workflow from the provider to the denial manager need to get up to speed on proper ICD-10-CM coding as soon as possible.
There are many in-person trainings, online courses and books being promoted to help with the ICD-10-CM transition. But when looking for that essential ICD-10-CM book that will become your constant companion for the next 6 months, there are 5 essential “must haves.”
1. Code Mapping – Almost none of the ICD-10-CM books include helps to translate your old ICD-9 codes to the new ICD-10 codes. Medicare published the General Equivalency Mappings or GEMs, but most publishers have chosen either to not include them in their books or to sell a separate book with just the GEMs. The ideal ICD-10-CM specialty book would include just those mappings needed for the specialty, in the same book.
2. Official Guidelines – About half of the books on the market have included the CD-10-CM Official Guidelines for Coding and Reporting, as published by the CDC and CMS (Medicare). But few books, if any, list the relevant sections in the Guidelines with each code or section of codes. No one is going to read and memorize all the Guidelines, so a book that lists Guideline references next to the codes is a must have.
3. Provider Documentation Guides – The real problem implementing ICD-10-CM won’t be figuring out which code to use. The real problem will be ensuring that the physicians and practitioners are specific enough in their documentation, that a coder or biller will be able to assign a the ICD-10-CM code at the highest specificity possible. Whether or not your practice, office, or hospital gets paid WILL depend on the level of your providers’ documentation.
The ideal ICD-10-CM code book will have specialty specific guides for providers to help them understand and make the changes in their documentation habits. These guides should show the familiar ICD-9 code and the new variations of the ICD-10 codes, as well as guidelines on what terms to include in the documentation to help the coders and billers assign the most correct code.
4. Enhanced Tabular Section – Most of the current ICD-10-CM books on the market simply regurgitate the ICD-10 code information without giving much thought to other information that would help coders and billers. An enhanced tabular section should include: references to the Guidelines, references to ICD-9 codes, alerts for gender, age, maternity, and manifestation codes.
5. Readable Font – Yes, a readable font. So many of the ICD-10-CM books that have been published over the past few years are in a microscopic font that will give you H53.10 (eye strain). The problem is most publishers try to pack the entire set of 70 thousand codes into one book. You will be grateful for an ICD-10 book that you can comfortably read as you refer to it more and more.
So there you have it. As you review the different types of ICD-10-CM code books and the handful of specialty books that are on the market, keep in mind these “must haves” and select a book that will work best for you.