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Spring 2009


Coding Corner: ICD-10: 2011

Sharon Hughes MBA, RHIA, CCS
Senior Director of Coding and Auditing, Anesthesia Business Consultants, LLC

A separate proposed rule calls for the adoption of an updated version of current Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards. This transition to the newer version of the HIPPA transaction standard must be completed by April 1, 2010, 18 months ahead of the ICD-10 implementation.

Implementation could happen earlier. Two years is the estimate for hospitals and other facilities to prepare to implement ICD-10 from the publication of the final rule. Under section 1175 of HIPAA, the earliest date CMS could implement ICD-10 could be 180 days after the issuance of a final rule, which is expected before the end of 2009.

CMS has recommended that health care organizations begin to document required changes for the transaction standard as early as September 2008, including initiation of education to begin by December of this year. It is time to prepare for the changes with regards to budgetary, training and information system implications for the administrative, clinical and financial departments. Improving medical record documentation practices is a tangible benefit that is gained even with the ICD-9-CM system but will be necessary for the new system.

Physicians, home health agencies, skilled nursing facilities, and post acute care settings will be affected by the change to the ICD-10-CM only. ICD-10 has approximately 68,000 diagnosis codes and 87,000 procedure codes compared to the 13,000 diagnosis and 3,000 procedure ICD-9-CM codes. The diagnosis codes each have three to seven alphanumeric characters, compared to ICD-9 which has two through five numeric digits with the exception of V and E codes where the first digit is alphabetical.

Undertaking design and system changes for compliance with the Version 5010 transaction standards must accommodate the increase in the size of the fields for the ICD-10 code sets. During the transition period, information systems software will have to support the ICD-9-CM as well as ICD-10-CM and the ICD-10-PCS coding systems potentially requiring additional data storage space. Even though data storage space is not as costly as it once was, it may be easier to run a report in the ICD-9-CM and a separate report in ICD-10-CM and/or ICD-10-PCS, and then to add up both reports manually.

Domain Reference Mapping

CMS has released updated domain reference mapping between the two coding systems to facilitate the linking between the procedure codes in the ICD-9-CM volume 3 and the new ICD-10-PCS code set. The General Equivalence Mappings (GEMs) are formatted as downloadable “flat” text files. The file contains a list of code pairs. Documentation and a user’s guide are available online at: www.cms.hhs.gov/ICD10/Downloads/pcs_gemguide_2008.pdf.

This guide will give you information regarding the structure and relationships contained in the mappings to facilitate correct usage. The intended audience includes but is not limited to professionals working in health information, medical research, and informatics.

Sections 1 and 2 will benefit clinical and health information professionals who plan to directly use the mapping in their work. A glossary is also available of the terms and conventions used in the mapping along with their accompanying definitions. Software engineers and IT professionals interested in the details of the file format will find the information in appendix A. Appendix B contains a table listing of the new I-9 procedure codes and their corresponding entries in the I-9 to PCS GEMs.

Also, check out this Sample ICD-10 Superbill which may be found at the following link: www.cms.hhs.gov/ICD10/Downloads/Sample_superbill_icd10.pdf