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Making the Transition to ICD-10

Posted on December 4, 2013 by American Sentinel University - Healthcare

Health care is going through a period of rapid change. Among them is the transition
to ICD-10, the coding system thats used to report medical diagnoses and procedures.
Hospitals and physicians groups must be ready to make the switch by Oct. 1, 2014.

How does ICD-10 affect nurses? In general, they will need to document patient
assessments and care with meticulous detail, so coders and billers can apply
the correct codes later.
So why the change? Basically, after 30 years of use, the ICD-9 system is considered
outdated it no longer adequately reflects advances in modernmedical practices and
technologies. And because of its structure, the ability to add new codes is limited, so it
no longer supports health reporting and payment processes very well. According to
theAmerican Health Information Management Association (AHIMA), ICD-10 has
already been in use across most of the world for the past decade, with the U.S. woefully
behind. The American system was adapted by the Centers for Disease Control and
Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS), from
a coding system developed by the World Health Organization (WHO).

A New Focus on Details

The greatest difference in ICD-10 is the level of specificity that it achieves more than
100,000 codes have been added to the two versions of the system that cover inpatient
and ambulatory care. The codes are now based not only on the type of diagnosis or
procedure being defined, but on the exact body part affected and other clinical details.
For example, a wound on the right leg will have a different code from a wound on the
left leg, and the initial patient visit for that wound will be coded differently than
subsequent visits. This level of detail did not exist in ICD-9, so the additional information
supplied by the new system is expected to benefit patients, providers, payers, and
organizations that track and monitor the global spread of disease.
While the more specific codes are expected to confer many advantages, clinicians will
also face the significant challenge of selecting the proper code every time they
document care. Doctors may be surprised to learn that, while there were four codes for
various manifestations of Crohns disease under ICD-9, there are more than 30 in ICD10. Nurses will find that pressure ulcers will have over 125 ICD-10 codes, up from nine
under ICD-9.
The new level of specificity has been the source of much good-natured
humor, particularly among health care bloggers, who have enjoyed pointing out the 312
new codes related to animal bites and attacks. An article in the Wall Street Journal
featured the light-hearted headline Walked Into a Lamppost? Hurt While Crocheting?
Help Is on the Way, along with the tongue-in-cheek tagline New Medical-Billing System
Provides Precision; Nine Codes for Macaw Mishaps. As it explains:
Indeed, health plans may never again wonder where a patient got hurt. There are codes
for injuries in opera houses (see code), art galleries (see code), squash courts (see
code) and nine locations in and around a mobile home (see codes), from the bathroom
to the bedroom. It will also have a code for recording that a patients injury occurred in
a chicken coop. (See code.)
With ICD-9, codes were three to five digits. In ICD-10, however, they can be up to seven
digits long and always begin with a letter. They look like this, in terms of structure and
level of detail:

CODE

Unspecified fracture of shaft of left ulna

S52.202A

Initial counter for closed fracture

S52.202B

Initial encounter for open fracture type I or II

S52.202C

Initial encounter for open fracture type IIIA, IIIB, or IIIC

S52.202D

Subsequent encounter for closed fracture with routine

healing

S52.202E

Subsequent encounter for open fracture type I or II with

routine healing

S52.202F

Subsequent encounter for open fracture type IIIA, IIIB, or

IIIC with routine healing

S52.202G

Subsequent encounter for closed fracture with delayed

healing

The Nursing Perspective

So how does ICD-10 affect nurses? In general, they will need to document patient
assessments andcare with meticulous detail, so coders and billers can apply the
correct codes later. In some cases, they may even have to go back to physicians for
more information. If nurses are not adequately trained in ICD-10 clinical
documentation requirements, insurance payments to patients or providers may be
delayed or denied.
Advanced practice nurses and nurse case managers who deal with patient insurance
may be more directly affected by the transition to ICD-10, as they may be assigning the
proper codes themselves.
Nurse informaticists may also be called upon to help with the transition from ICD-9 to
ICD-10, as hospitals and physician practices work to modify clinical documentation
processes and workflows.
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Source: http://www.americansentinel.edu/blog/2013/12/04/making-the-transition-toicd-10/