10 things you should know about ICD-10 requirements and your upcoming transition.

1. Increase in number of Codes and Specificity

  • Addition of more than 125,000 new diagnosis and procedure codes
  • Will demand a high level of coder expertise in the areas of anatomy, physiology, pathophysiology and medical terminology

2. ICD-10 has tens of thousands of more terms than ICD-9-CM. To use ICD-10 effectively coders must know:

  • Greek and Latin prefixes, suffixes, roots and combining forms used as the basis of most medical terms
  • Commonly accepted and approved medical abbreviations
  • Eponyms and names of syndromes
  • Alternative names and descriptions for diseases
  • Adjectives used to describe and define diseases and disorders (purulent, necrotic, etc.)
  • Verbs and terms used to describe surgical approaches and techniques (resect, dissect, incise, excise, aspirate, -scopic, -otomy, -ectomy, etc.)
  • Technology driven and manufacturer given names for tests, devices and procedures

3. Changes will impact all departments

  • Need multi-disciplinary approach
  • Planning needs to include representatives across all departments that are impacted

4. Enormous healthcare-wide impact

  • All Providers
  • All health plans and payers
  • Technology solutions that require coding input

5. First FULL replacement in 30 years

6. Complicated Mapping

  • No one-to-one mapping from ICD-9 to ICD-10
  • There may be multiple one-to-one possibilities
  • There may be multiple cluster possibilities, with each ICD-10-PCS code a complete procedure while ICD-9 may be a combination of codes

7. Anticipated short-term consequences of implementation

  • Coding productivity estimated to decline by 10% – 15%
  • Declining reimbursements and increased days in A/R (quantify?)
  • Increased claims denials

8. Anticipated Long-Term Benefits

  • Improved analytics based on increased specificity
  • More accurate reimbursements

9. Extensive foundational Knowledge will be required

  • Medical record fundamentals
  • Coding fundamentals
  • Documentation guidelines
  • Anatomy
  • Physiology
  • Pathophysiology
  • Pharmacology
  • Medical and Surgical Procedures
  • Medical Terminology

10. Training is Critical

  • “Based on industry feedback regarding the need for more time than the 40 hours of training we estimated for inpatient coders to learn both ICD–10–CM and ICD–10–PCS, we will increase our estimate of the number of hours of training that inpatient coders will need to learn ICD–10–CM and ICD–10–PCS from 40 hours to 50 hours,well within the commenters’ suggested range of as little as 5 hours of training, to a maximum of 80 hours.”
  • “For successful transition to ICD10, the challenge for inpatient coders is to:
  • Ensure they have sufficient foundational knowledge of the biomedical sciences
  • Learn how to apply both ICD-10-CM and ICD-10- PCS codes correctly on inpatient encounters
  • Understand how to apply maps and crosswalks between ICD-9-CM and the ICD10 systems “

Source: Role-based Model for ICD-10 Implementation: Inpatient Coder Tasks(published on AHIMA website in November 2009)