How medical billers and coders can prepare for ICD-10 certificationBy Sonia Vittori, May 23, 2013
Effective October 1, 2014, the Department of Health and Human Services (HHS) is replacing the now-inefficient and outdated ICD-9-CM code sets with the more specific ICD-10 CM code system. The ICD-10 framework is likely to bring significant changes to the medical billing and coding profession. Starting the training process now with early preparation could contribute to a smoother transition, as well as potentially higher productivity levels in the long run.
The International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) offers the healthcare industry an enhanced structure aimed at achieving more accurate payment for medical services. According to the American Health Information Management Association (AHIMA), the new system increases opportunities to help improve the quality of care that patients receive, as well as provide more meaningful data to better track healthcare outcomes.
Rollout of ICD-10 in the U.S.
ICD systems are overseen by the World Health Organization. The implementation of ICD-10 code sets in the United States offers improvements concerning the classification of medical information. The Centers of Disease Control and Prevention (CDC) reports that as of 2009, plans were set to make the transition in 2013, but a government decision in 2012 deferred implementation until 2014.
A number of countries, including the United Kingdom, Germany, France and Canada, are already using the ICD-10 CM coding system. According to AHIMA, embracing the new code sets means the United States would no longer be the only developed country that hasn't adopted the more advanced classification system. ICD-9 CM holds the country back from participating in vital global data sharing. For example, ICD-10 allows coders to participate in advanced tracking and early detection of complex health issues, such as bio-terrorism events and public health outbreaks, including the West Nile Virus and SARS.
ICD-10 CM improvements to learn
The ICD-10 classification system could lead to more precise medical data to heighten the efficiency of healthcare in the U.S. The new code system should also make it easier to identify ways to improve the overall safety and quality of healthcare.
The organization, structure, code composition and level of detail regarding ICD-10 CM are much different than ICD-9 CM. The CDC notes that the new ICD-10 CM coding structure allows further growth, and addresses rapidly changing technology in a way that wasn't possible before. ICD-10 offers various improvements, such as greater specificity in code assignment and the addition of information relevant to ambulatory and managed care encounters.
One of the biggest changes regarding ICD-10 CM is the number of codes that professionals must learn. AHIMA estimates there are more than 68,000 codes in the new system, as opposed to about 13,000 codes for ICD-9-CM.
Other improvements to the system include:
- ICD-10 CM integrates new diagnosis/symptom codes, where using combination codes reduces the number of codes needed to fully describe a condition. In many cases, the new codes are longer. Other ICD-10 code changes involve the classification of conditions, such as diabetes, alcohol/substance abuse, and postoperative complications.
- ICD-10 incorporates alphabetic codes to allow a greater level of specificity.
- Coders learn expanded injury codes with the addition of possible sixth and seventh characters with the ICD-10 system. New codes can consist of up to seven digits, with the seventh digit extensions referring to visit encounters or after-effects and secondary results of injuries and external causes.
- Coders learning ICD-10 encounter many organizational changes. For example, the V and E codes of ICD-9 are no longer supplemental classifications. Also, the CDC describes ICD-10 as having nearly twice as many categories as ICD-9.
Although ICD-10 codes and guidelines are currently not valid in the workplace, the CDC reports that the system is available for the public to view. Implementation plans and training for the new code sets are already in place across the nation.
Potential benefits of early ICD-10 training
The North Carolina Healthcare Information and Communications Alliance, Inc. suggest that early preparation and adequate education combined with proper testing can make transitioning into the new classification system easier. Benefits of early ICD-10 CM training could include:
- A smoother transition period: Early ICD-10 CM training could help during the move to the new system for medical billing and coding professionals. The structural transformation of the entire coding system may create an increased level of difficulty and higher demands on employees. Familiarity with ICD-10 could ease the transition for both employees and employers.
- Keeping up with new recruits: Health Leaders Media reports the ICD-10 CM transition means a new generation of coders are being recruited and trained to use ICD-10 CM. Early training could help the present pool of coding professionals prepare for the changes, adjust their old coding habits, and stay up to date.
- Maintaining productivity: Training could influence productivity levels, according to UASI, a service provider. Early results of a UASI-conducted ICD-10-CM/PCS Productivity Study show a large drop in productivity in a test of ICD-10 CM/PCS coding exercises. Results show coders taking an average of 17.72 minutes or 69% longer to code a record in ICD-10-CM/PCS, with the biggest chance seen in a coder taking an additional 27.78 minutes (89.8%) on average per case. However, consistent ICD-10 training appeared to offer a return on investment regarding staff training time. For example, three coders with AHIMA ICD-10 trainer certification took an average of 14.7 additional minutes (54.4%) to code individual cases.
- Identifying challenges: Optum Coding, a service provider, suggests that early ICD-10-CM training and usage can improve long-term results. Getting acquainted with the new coding guidelines enables coders and organizations to identify the areas of clinical documentation that require the most improvement. Highlighting possible insufficiencies concerning code set training early on could reduce the number of obstacles that coders and educators face when it comes time to officially implement the new system.
Resources available for ICD-10 CM training
AAPC, which offers certification for medical coders, estimates that widespread training for the ICD-10 code starts in late 2013 if not 2014, and typically centers on implementation training, anatomy and pathophysiology, code set training, specialty code set training and a proficiency assessment. In preparation for the October 1, 2014 deadline to implement the ICD-10 CM system, a range of educational and training options are available to familiarize medical billing and coding professionals with the new guidelines:
- Online ICD-10 CM courses: E-learning modules for independent learners allow coders to experience ICD-10 at their own pace.
- Educational downloads: Offering information on the upcoming changes in coding, the National Center for Health Statistics website provides professionals with downloads of the ICD-10-CM index, guidelines, addenda and general equivalence mapping files.
- Coding news: Organizations, such as the American Hospital Association (AHA), post updates and news for coders and offer audio coding clinics to help address issues with the implementation of ICD-10 and seek to establish a solid foundation in accurate ICD-10-CM coding.
- On-the-job application-based training: Current coding professionals can participate in on-site or remote on-the-job application-based training as a way to reinforce ICD-10 fundamental concepts and practice coding cases using ICD-10 guidelines.
- College training modules: Higher learning institutions now prepare professionals for the ICD-10 changes with course instruction, both online and offline. Training modules may review the fundamentals (such as anatomy and medical terminology) and application of ICD-10-CM/PCS codes.
- ICD-10 CM Bootcamps: Interactive group environments offer in-person training. AAPC introduces coders (starting July 2013) to ICD-10 guidelines and exercises in a 'boot camp-style' atmosphere.
Early training and certification in the new ICD-10-CM coding system can be valuable assets to help employees and students develop the most up-to-date practices in medical billing and coding. The outdated terminology and codes in ICD-9-CM could result in inaccurate and limited data, and this 30-year-old system can no longer meet the needs of current medical practice. ICD-9-CM codes could fail to correctly describe the diagnoses and inpatient procedures of the 21st century, which is why ICD-10 CM is becoming the standard for the United States.
Article brought to you by Sonia Vittori, who owns and runs codingcareers.org. Sonia is a Medical Billing and Coding specialist and avid blogger.