While the compliance date for the mandatory switch from the current ICD-9-CM/PCS (International Classification of Diseases, 9th Edition, Clinical Modification/Procedure Coding System) to the new ICD-10-CM is not until October 2013, now is the time for all therapists to start preparing for a smooth transition. ICD-9-CM codes will not be accepted for services provided on or after Oct. 1, 2013, and ICD-10 codes will not be accepted for services prior to Oct. 1, 2013.
Why the Change?
The 30-year-old ICD-9-CM system, despite the yearly updates, is outdated. It has not kept pace with current medical practice and does not provide the necessary detail for patients' medical conditions or the procedures and services performed on hospitalized patients. The outdated and obsolete terminology still in place limits the use of its data for effective research. The system just no longer accurately describes the diagnoses and inpatient care procedures that are currently being delivered. In addition, the ICD-9 is running out of codes; hundreds of new diagnosis codes are submitted annually.
Most European countries and Canada have already made the transition to ICD-10, which is owned by the World Health Organization. The ICD-10-CM is the United States' modification of the ICD-10.
What It Will Offer
The new classification system captures the advancements that have been made in clinical medicine and provides significant improvements through greater detailed information and the ability to expand the ICD-10. It will allow for more codes and better data tracking of incidence and prevalence of disease. The ICD-10-CM and ICD-10-PCS are unquestionably more detailed - by a factor of two in diagnoses (and 20 for injuries) and by a factor of 50 in procedures.
As examples, under the current ICD-9 system, there are no codes to distinguish whether it is a right or left extremity that is fractured; this is corrected in ICD-10. Now, under the ICD-9-CM codes for pressure ulcers, none cover the depth or stage of the ulcer. In the ICD 10 Manual, there are now 125 codes for pressure ulcers.
How to Prepare
Therapists in all settings will need to be trained in the new code sets. Hospital-based therapists will need both ICD-10-CM and ICD-10-PCS training, whereas outpatient and private practitioners will only need ICD-10-CM updating. Private practitioners need to determine which key personnel need the training and to what extent. All internal processes should be examined to see what will need updating.
Any existing software for claims submission, billing and electronic medical records, including all "super bills," will have to be modified or possibly replaced. Now is the time to find out whether you can upgrade your existing system or if you will have to buy a new one; do not wait until the last minute to negotiate this with your software vendor.
For those who use outside billers or clearinghouses, find out now the specifics of their preparation/implementation for the transition, and whether any new costs associated with this will be passed along to you. Make sure you factor in time for internal and external testing of any new systems and reprinting of manuals and other materials (there will be more than 52,000 new codes).
Everyone realizes that this transition will be costly, take time, and probably result in initial decreased back-office productivity. One simple way to get started is to prepare a comparison/crosswalk chart of ICD-9 to ICD-10 codes commonly used by occupational therapists. Anyone considering buying software of any kind in 2011 or 2012 should ask what provisions will be offered for the 2013 transition.
Iris Kimberg, MS PT, OTR, has worked in the non-clinical aspect of therapy for the past 30 years. She is the founder of New York Therapy Guide (http://www.nytherapyguide.com), a site dedicated to the growth, viability and success of therapists in the private sector. Iris now enjoys sharing her expertise with others in the field through workshops, seminars and private consultations. She can be reached at firstname.lastname@example.org.