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Article Date: 1/1/2014

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Coding Strategy
coding strategy

Preparing for the ICD-10s

Will you be ready?

images

JOHN RUMPAKIS, O.D., M.B.A.

By my math, we are a short 8 months away (Oct. 1, 2014) from the ICD-10s being implemented in the U.S. There has been quite a bit of information about preparing for the ICD-10s that have been published in this publication and others, so don’t say you haven’t been warned, because there has been plenty of time to get prepared.

While many would have you think that the implementation of ICD-10 is going to be medical Armageddon, your practice can easily be ready to incorporate the new coding system smoothly into your daily routine with some orchestrated planning, preparation and implementation.

CMS (Centers For Medicare & Medicaid) has some wonderful planning and implementation resources that are free to download (http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10). I would pay particular attention to areas such as the Implementation Planning & Timelines and the Medscape Learning Modules designed for small practices.

Sample Codes

ICD-9 ICD-10
367.21 H52.221 Regular Astigmatism, Right Eye
Regular H52.222 Regular Astigmatism, Left Eye
Astigmatism H52.223 Regular Astigmatism, Bilateral
H52.229 Regular Astigmatism, Unspecified Eye
For other codes, such as blepharitis, there is not only laterality, but we have to specify the individual eyelid as well.
ICD-9 ICD-10
373.00 H01.001 Unspecified blepharitis, right upper eyelid
Blepharitis H01.002 Unspecified blepharitis, right lower eyelid
Unspecified H01.003 Unspecified blepharitis, right eye, unspecified eyelid
H01.004 Unspecified blepharitis, left upper eyelid
H01.005 Unspecified blepharitis, left lower eyelid
H01.006 Unspecified blepharitis, left eye, unspecified eyelid
H01.009 Unspecified blepharitis, unspecified eye, unspecified eyelid

ICD-10 vs. ICD-9

ICD-10 is a completely different system than ICD-9 and much more specific, but I think most will find it very logical in how the codes are constructed.

Currently with the ICD-9 diagnosis codes, each code has three to five digits (three digits before the decimal, and up to two after the decimal, e.g. 123.45), with most having five because we’re obliged to always code to the highest level of specificity. The ICD-10 is a completely different system and has different conventions and foundational rules that we’ll have to learn and get comfortable with.

ICD-10-CM (Clinical Modification) has three to seven digits/characters (the alphabetic ones are not case sensitive):

▸ Digit one is alpha (i.e., A to Z — H is the category for eye disorders)

▸ Digit two is numeric

▸ Digit three is alpha or numeric (followed by a decimal)

▸ Digits four to seven are alpha or numeric

(For a breakdown of codes in the ICD-9 system vs the ICD-10 system, see “Sample Codes,” below.)

The ICD-10s also require more space. In anticipation of this, CMS has released a new CMS-1500 form (http://www.nucc.org/content/archive/2014/January/images/stories/PDF/1500_claim_form_2012_02.pdf) that became required to use on Jan. 1, 2014 that provides the ability to code up to 12 ICD-10 codes in the diagnosis section vs. the four ICD-9s that could be listed previously.

Getting started

There is no time like the present to start setting goals and target dates for implementation of this critical change in practice. OM

DR. RUMPAKIS IS PRESIDENT AND CEO OF PRMI, A CONSULTING FIRM FOR THE HEALTHCARE INDUSTRY. A PROLIFIC LECTURER, HE IS ALSO THE DEVELOPER OF A CLOUD-BASED CPT/ICD DATA & INFORMATON SERVICE. SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.



Optometric Management, Volume: 49 , Issue: January 2014, page(s): 62

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