Debunking ICD-10's biggest myths

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) addressed several misunderstandings around ICD-10 in its ICD-10-CM/PCS Myths and Facts guide. While CMS debunked some of the most common ICD-10 myths, much of the industry is still confused about key topics, such as whether the ICD-10 deadline will once again be extended or which payers are required to transition to ICD-10.

With less than a year until ICD-10, providers cannot waste time believing anything but the truth. Here are the facts about just a few of the ICD-10 myths that are still circulating, as well as some tips to help overcome these ICD-10 obstacles.

Myth: There will be another delay to the ICD-10 implementation deadline.

CMS has confirmed that there will be no more delays, but it’s understandable why so many people expect one. We already received a year-long extension from the original deadline in 2013, and much of the industry is still behind in preparation. Despite this, October 1, 2014, is still the official deadline, and it is important that healthcare organizations are prepared to submit claims with ICD-10 codes by this date. Pat Brooks, senior technical advisor at CMS, confirms that “the ICD-10 implementation date will not be delayed further.”

With just under a year left to prepare, it’s essential that you plan well to be ready for the transition. CMS has an excellent online ICD-10 guide that can help you think through your transition plan. As you are preparing, think about everywhere you currently use an ICD-9 code, and create a gap analysis so these areas can be modified for ICD-10.

Training your staff for ICD-10 also will need to be a major focus, since billers and coders will need to code in the new system. Remember to include time to train your physicians and clinical staff, since they will need to know what type of documentation to provide in patient charts to help the coders identify the appropriate ICD-10 code.

Even with thorough planning in place, it is still possible that you will experience payment delays once ICD-10 takes effect. It is strongly recommended that you establish a loan or line of credit to help tide your organization over if you experience delays in reimbursement during the transition.

Myth: State Medicaid plans are not required to transition to ICD-10.

All entities coved by HIPAA will need to transition to ICD-10, and this includes all state Medicaid plans. Major industry changes like this are challenging for state Medicaid plans due to their limited funding, so CMS is providing special assistance to help them with this massive transition. However, it is possible that some state Medicaid plans will not be ready by the October 1, 2014, deadline.

Other payers that are not covered by HIPAA, such as property and casualty, workman’s compensation, and auto insurance, are encouraged, but not required, to become ICD-10 compliant. While some states are requiring these payers to transition to ICD-10, others will not switch to ICD-10.

You likely will continue to use ICD-9 codes for at least some payers after October 1, 2014, such as those not covered by HIPAA and state Medicaid plans still in transition. It will be important to talk with your practice and revenue cycle management vendors and clearinghouse to make sure your system can accommodate both ICD-9 and ICD-10 code sets, so your revenue from these payers is not at risk.

Myth: The GEMs were developed to provide help in coding medical records.

CMS developed the GEMS, or General Equivalence Mappings, to help guide the industry as we convert payment systems, coverage edits and other databases from ICD-9 to ICD-10.

While the GEMs are helpful to show which ICD-10 codes may correspond to your existing ICD-9 codes, they are not intended to be used to code ICD-10 claims because they do not include all the necessary information for the coding process. When providers code claims, they need to refer to clinical documentation in the patient’s medical record to identify the most appropriate ICD-10 code. The ICD-10 code set has more than five times the amount of codes as ICD-9, so the detail in the patient record will provide the specificity coders need to choose the correct code.

Considering these three common myths, it’s clear that misleading information could have a serious impact on providers’ ICD-10 readiness. I strongly urge providers to check out reliable resources, like www.cms.gov/icd10, your professional associations, and your clearinghouse and PMS vendors, to make sure you are taking the proper steps to prepare your organization by the October 1, 2014, deadline.