If you are in healthcare, you’ve heard the warnings. ICD-10 is coming… to all clinical practices in the United States. ICD-10, or the International Classification of Diseases 10th Edition, was actually started way back in 1983 by the World Health Organization and endorsed in May 1990. ICD-10 has been used in the United States on death certificates and in the tracking of mortality data since 1999. Other countries have been using it starting with several in the late 1990s to about 110 countries using it for at least mortality data currently. It is a code set that allows all medical professionals to speak the same language. ICD-10 allows for better tracking of disease trends and allows for comparison of individuals to help improve outcomes.
The ICD-10 code itself can contain up to seven characters. The first three characters make up the disease category. Within these, the first character is always alphabetic, the second numeric and the third can be either. After these characters there is a decimal point. The next three characters give more information about etiology (cause), anatomical site and severity of the condition. The seventh character is called the “extension code”. In injuries and external causes, it designates an Initial Encounter (A), Subsequent Encounter (D) or Sequela* (S). When coding fractures, the extension code indicates an Initial Encounter for Closed Fracture (A), Initial Encounter for Open Fracture (B), Subsequent Encounter for Fracture with Routine Healing (D), Subsequent Encounter for Fracture with Delayed Healing (G), Subsequent Encounter for Fracture with Nonunion**(K), Subsequent Encounter for Fracture with Malunion*** (P), or Sequela (S).
An “X” is used as a placeholder when the extension is needed but the code does not contain all of the prior six characters.
The ICD-10 code set allows for greater coding specificity. To give you an idea, there were about 14,000 codes in ICD-9. Compare that to the approximately 69,000 codes in ICD-10. That’s over a 400% increase in usable codes. And because the codes can contain letters or numbers, it allows for more flexibility in expanding the code set in the future.
* “Sequela” is a condition that is caused by another disease
** “Nonunion” is a permanent failure of a broken bone to heal
*** “Malunion” is where a broken bone heals but not in the optimal position
How will this affect the healthcare industry? For providers who bill per visit, any invoices submitted with dates of service on or after October 1, 2015 will need to contain ICD-10 diagnosis codes. This only affects the diagnosis codes that were previously coded in ICD-9. It will not change CPT codes, HCPCS codes, HIPPS codes, etc. For therapyBOSS clients billing insurance, we highly recommend that claims with service dates before October 1st and claims with service dates on or after October 1st be billed separately to decrease the chance of denials of your claims. therapyBOSS will automatically use the ICD-10 or ICD-9 codes depending on the date of service.
For home health agencies that bill episodically things are a bit more complicated. There are three components that determine how you code: the claim “from” date, the claim “to” date and the Date Assessment Completed (M0090) of the OASIS. Any claims that have all three dates before October 1, 2015 will be coded in ICD-9 while claims with all three dates after the conversion date will be coded entirely in ICD-10.
The claims with dates both before and after the conversion date are going to be more of a challenge. The OASIS version and the codes to go into the OASIS are determined by the M0090 date of the OASIS. If the date is before 10/1/15, OASIS C1-ICD9 is used and ICD-9 diagnosis codes. IF it is after 10/1/15, OASIS C1 and ICD-10 diagnosis codes are used. The ICD codes that are used on the claim are determined by the “through” date of the claim.
Here’s the tricky part. The HIPPS code must be the same for the RAP and the final claim. So if you billed a RAP prior to October 1st it would have been billed with the HIPPS code configured from ICD-9 codes. So if your final claim is dated after October 1st, your claim must contain ICD-10 codes. However, the HIPPS code that is submitted with the final claim will be the HIPPS code from the RAP regardless of whether the new ICD-10 codes change the HIPPS code. The good news is that this is only for claims in this transition period and CMS is going to have some flexibility in dealing with these claims. Most home health software should already be asking for you to dual-code any claims with a RAP date on or after August 3rd. If your system is not, you should speak with your vendor as soon as possible to ensure that you will be ready on October 1st.
CMS has created a handy checklist to help providers to get ready for ICD-10. You can see it here. The absolute most important thing to do immediately is to ensure that your coders have access to an ICD-10 coding resource. It is also vitally important to ensure that your software vendor is ready for ICD-10 and that you will be able to submit compliant claims on October 1st. If not, you will need to ensure that you follow up with your Fiscal Intermediary’s ICD-10 Claim Submission Alternatives Instructions. Links to those instructions are provided below.
A release is planned for September 18th that will enable ICD-10 codes in the system allowing providers to look them up and add both ICD-9 and ICD-10 codes. For clients billing insurance, we are offering to help add ICD-10 equivalents based on existing ICD-9 codes. Please note that you would need to specify to us an ICD-10 code or multiple codes that you would like to see reflected for each ICD-9 code. Unfortunately, more often than not, there isn’t a straight match between the two. However, there are resources that can help you make the determination. Do keep in mind that for dates of service on and after October 1st, therapyBOSS will look for ICD-10 codes to place on the claim. That’s also why you want to bill for services prior to October 1st separately from services that take place after.
The release on September 18th will have the updated OASIS-C1 forms.
If you have any questions, please contact us at firstname.lastname@example.org.
Home Health instructions: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1410.pdf
CMS ICD-10 general information: www.cms.gov/medicare/coding/icd10
CMS “Road to 10”: www.roadto10.org
World Health Organization (WHO) ICD-10 website: www.who.int/classifications/icd/en
If your software vendor cannot or will not be ready for ICD-10, here are some ICD-10 Claim Submission Alternatives listed by Fiscal Intermediary:
Ask a Question
We’ll open a ticket and send you an immediate confirmation. You’ll be getting a response from us soon after.