By James Swann
March 29 — Roughly 6,000 new codes will be added to ICD-10 this coming October, a significant increase from previous coding updates under the old system when changes often numbered 50 or fewer new codes.
Scot Nemchik, vice president of coding education at CIOX Health, a health information management provider in Green Bay, Wis., told Bloomberg BNA March 28 that although the magnitude of the coding updates seems dramatic, the growth is largely driven by the addition of five new medical procedures, requiring several new codes.
ICD-10 codes offer greater granularity and specificity than ICD-9 codes did, Nemchik said, meaning that a new procedure will have multiple codes attached. The coding update was announced during a Centers for Medicare & Medicaid Services ICD-10 Coordination and Maintenance Committee meeting March 9.
The last coding updates were made in October 2011. The International Classification of Diseases, 10th Revision, which took effect Oct. 1, 2015, updated and increased the number of health-care diagnoses and procedure codes from ICD-9's 13,000 codes to 68,000 codes. All organizations that are required to comply with the Health Insurance Portability and Accountability Act have to use ICD-10 codes to identify diagnoses and procedures on health-care claims.
As the new codes become part of the system, Nemchik said, coding to the highest level of specificity will become critical.
Nemchik said the whole point of ICD-10 was to get granularity and specificity into the code set, and if coders don't code properly, the Medicare payments could be lower than they should be for the procedures.
For example, if coders fall back on ICD-9 methods by relying on unspecified category codes, the CMS could end up paying providers less than they would otherwise be reimbursed.
“CMS has the leverage to reduce payments,” Nemchik said.
The five new procedures, which Nemchik said covered 75 percent of the new codes, are for face and hand transplants, bypasses involving animal tissue, new body part valves, thrombectomy procedures performed on arterial bifurcations and root operation dilation in the lower arteries and body arteries.
Coronary Bypass Codes
Under ICD-9, a procedure like a coronary artery bypass often had one code attached, whereas ICD-10 requires coders to denote such details as the specific artery where the bypass took place and the surgical approach used in the procedure, Nemchik said.
Therefore, a single new medical concept, such as the use of animal tissue in bypasses, will result in dozens of new codes.
Nemchik said that while the number of new codes might seem big, coders won't have to learn them all but will instead focus on the underlying new procedure.
“You're not having to train coders on all the new codes, just the single concepts,” Nemchik said.
Prepare Now
Nemchik recommended providers begin preparing to use the new codes. Starting now gives coders around seven months to adjust, he said.
“If you have a leader to boil down the new codes to their individual concepts, that would be best,” Nemchik said.
Robert M. Tennant, director of health information technology policy at the Medical Group Management Association, told Bloomberg BNA March 29 that the coding update shouldn't be overly burdensome for physician practices that have the codes embedded in their practice management software or electronic health records.
However, practices that are using hard copy code books will have to get updated code lists, Tennant said.
“In general, we are recommending that practices review the new code additions and modifications to ensure that staff providers and coders are well-acquainted with the specific codes that impact their specialty,” Tennant said.
Coding Productivity
While the ICD-10 rollout has been smooth, Nemchik said it has resulted in a 25 percent reduction in productivity, as more detail is needed for the codes. Nemchik said some industry stakeholders thought there would be a 50 percent reduction, and in that light a 25 percent reduction is good news.
Moving forward, Nemchik said, the accuracy of ICD-10 coded claims remains to be seen.
Nemchik said recovery audit contractors were “wildly successful” in finding inaccuracies within ICD-9 coded-claims, adding that the jury's still out for ICD-10.
“To think all of our accuracy issues have gone away with ICD-10 is crazy,” Nemchik said.
To contact the reporter on this story: James Swann in Washington at jswann1@bna.com
To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com
