Prepared for medical coding changes?


On Oct. 1, 2014 -- just 19 months from now -- the U.S. healthcare industry will begin using a new coding system for the first time in more than 30 years. The change has been a long time coming, and now it’s almost here.

Consultant Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA, who specializes in medical information and coding, says there are some key differences between the current ICD-9-CM coding system and the new ICD-10-CM codes:

  • Longer codes and more of them. The new codes are alphanumeric, eliminating supplementary classifications and cause-of-injury codes. ICD-10-CM also has 68,000 codes compared to the old system’s 13,000. However, physicians will use only a small number of the codes related to their specialties.
  • Diseases will be organized and categorized differently, including simplified codes. Thanks to feedback received from medical specialty societies, more appropriate terminology will be used in the new system. And complex conditions will now be identified by one code instead of two.

For physician practices, now is the time to lay the groundwork for the transition by assessing your office’s computer system, readying the staff and making a plan for implementation. It’s also a good idea to provide your employees with some general information about what to expect during the transition.

Here are some suggestions for how to prepare your practice for the big switch:

  • Coders should update their skills. The American Academy of Professional Coders (AAPC) suggests that because of the increased clinical nature of the ICD-10-CM system, coders must have a strong understanding of anatomy and pathophysiology. If they don’t, they should take a refresher course. In addition, if coders will be using new technology to help with ICD-10-CM coding, then this would be a good time to assess their computer skills. While the installment of new technology isn’t essential for the transition, coders should be prepared if new systems are brought into the office.
  • Physicians and coders need to use the same language. Physicians should work with coders to understand why they must be more specific in their documentation and to learn exactly what information the coders need. Jackie Stack, CPC, has this advice:
  1. Look at how physicians in the practice document their charts now and see whether those notes can be coded via ICD-10-CM.
  2. If the documentation is insufficient for ICD-10, pinpoint what needs to change.
  3. Avoid using unspecified codes as they could affect future revenue. Be as specific as possible.
  4. Determine the physicians’ most frequently used codes. This will give you a good idea of which codes to start working on with the physicians.

Small practices must determine whether their staff will have sufficient time to accomplish the transition. If not, then some level of outside help will be required. And with this massive changeover looming, many training options in the actual use of ICD-10-CM and the associated guidelines are now available. But the coders in your practice shouldn’t train with hospital coders because their areas of focus are entirely different.

Another option is to identify the “coding expert” in your practice, someone who is thoroughly familiar with ICD-9-CM and who, once he or she is trained, can help prepare the rest of the coding staff to use ICD-10-CM. This person should also determine whether documentation improvement might help the practice. While a complete overhaul may not be necessary, this would be an ideal time to develop the physicians’ skills in documenting information to assist with correct code assignments. And working together before the implementation of the new system is essential to ensuring a smooth transition for all.

Accurate coding goes hand in hand with medical billing. Keeping the financial health of your practice strong during this coding transition could require the assistance of a medical billing company. Make sure the process is streamlined by enlisting the help of people who understand how the new coding regulations will affect your medical billing.

The good news is that while the ICD-10 transition will be disruptive in the short term, it should have a long-lasting positive effect by improving the delivery of healthcare through more precise diagnoses and more accurate matches between the payment for care and the actual care delivered. In time, this improved precision will make care documentation and claims processing more efficient.

David Doyle is CEO of CRT Medical Systems, a medical billing company based in Novi, Mich. He founded the company in 1981. The firm currently ranks as one of the top 100 billing companies in the United States. Prior to starting CRT, Doyle worked as a lead programmer for large corporations and governmental agencies. He also created companies for IT staffing, programming and enterprise software sales.