ICD-10-CM is a new set of diagnostic codes which will replace the current ICD-9 standard of diagnostic codes. They provide greater detail in describing the diagnoses, clinical back- ground, and the origin of the disease, and there are many more of them (69,099 vs. 14315)! They are alphanumeric, longer, and always begin with a letter. It is anticipated that they will reduce or eliminate the need for additional supporting documentation, and provide more accurate reimbursement levels.
The deadline for all healthcare entities to comply is October 1, 2013. There is a dual coding period proposed from January 1, 2013 to October 12, 2013, which will provide a rolling implementation period for payers and providers to become compliant. Different insurance payers may have earlier deadlines, but the final cutover date wil be October 1, 2013.
No! Practice Insight will be testing with all the payers that you submit to. You will not have to test your own files for compliance. If your billing system will generate ICD-10 compatible claims, then you may ask TechMasters to submit test batches to Practice Insight for you, if you like.
GEM stands for General Equivalency Mapping and are basically tables that attempt to correlate ICD-9 and ICD-10 codes, providing a “cross-walk”. Unfortunately, this is not an easy task, as there is not a one-to-one match of codes in either direction. However, both as a learning tool, and as a way to convert applications, these tables are excellent guidelines for the transition. It is very likely that GEMs will become the basis for “upconverting” and “downconverting” between systems that use different coding levels.
At this time it is not clear how systems that use the older ICD-9 coding will comply with the new ICD-10 coding. Most older billing systems are capable of handling the longer alphanumeric codes in their databases; the challenge is more in the education of the staff and providers on how to use the new codes. However, the sheer number of ICD-10 possibilities will make it near impossible to have a single page encounter form where a provider checks off applicable codes. A recent study concluded that a fairly straightforward 1-page encounter form would be 24 pages long under ICD-10! Because of this, we are advising practices to begin implementing EMR systems that will generate CPT and ICD-10 codes for the visit, based on the provider’s documentation input.
There are a few things you can do RIGHT NOW to become ready. The first is to become educated on ICD-10 coding, attend online webinars, trainings, and various meetings, and learn what will be involved in coding and reimbursement under ICD-10. Many practices do not currently have a coder on staff, but these changes will likely mean every practice will need to become educated. The second is to work on implementing a certified EMR system, which will be able to generate appropriate coding for providers based on the visit documentation, and move the practice away from reliance on paper superbills.