What Cardiothoracic Surgeons Must Know About ICD-10

STS News, Spring 2014 -- At some point in the future, the ICD-9 coding system is slated to be replaced. The codes used to report outpatient and inpatient diagnoses, as well as hospital inpatient procedures, will transition to ICD-10-CM (clinical modification) and ICD-10-PCS (procedural coding system). You need to know how the ICD-10-CM/PCS transition will affect your cardiothoracic surgical practice and what you should do to prepare for the transition.

Two Components Involved
There are two distinct components to ICD-10. One is ICD-10-CM—the diagnosis codes. Physicians, hospitals, and other HIPAA-covered entities must transition to these new codes; however, some payments, such as those under workers’ compensation, are not required to use ICD-10-CM. Thus, you may have to accommodate both ICD-9-CM (the current diagnosis coding system) and ICD-10-CM in your practice.

ICD-10-CM is similar in function to the current ICD-9-CM system. The way you look up codes will not change, but the new codes will look different. ICD-10-CM accommodates up to seven alphanumeric characters. Compared to ICD-9-CM, which has approximately 14,000 diagnosis codes, ICD-10-CM explodes to approximately 69,000 diagnosis codes with more specificity.

For example, simple laterality (right vs. left) accounts for a significant increase in the number of codes. Many ICD-10-CM cardiothoracic diagnostic codes have the same wording as ICD-9-CM; however, in other situations, multiple diagnostic code options are available that more specifically define a disease. You will be expected to provide these more detailed codes. The layout and progression of the changes in ICD-10-CM are generally very logical.

The second part of ICD-10 is ICD-10-PCS. Hospitals are the main entities that will bear the burden of this transition. While hospitals are paid on Medicare Severity-Diagnosis Related Groups, the MS-DRGs are based on a combination of the principal diagnosis, secondary diagnosis, and procedures. The ICD-10-PCS adds markedly increased specificity to the hospital procedure coding process, which is required to report hospital inpatient services.

ICD-10-PCS is an entirely new coding structure, which is radically different from ICD-9 procedural coding. The current ICD-9 procedural coding system contains approximately 3,824 codes; the ICD-10-PCS contains approximately 72,589 codes. The ICD-10-PCS system utilizes a series of tables to build a seven-character alphanumeric code. Each component of the table has a defined purpose, and the words used within the system have defined meanings.

Nonetheless, the language in ICD-10-PCS is not the same language typically used by surgeons in their documentation or recognized by coders. Eponyms and common names, such as CABG, Fontan, Ivor Lewis, and Nissen, are no longer represented, necessitating that hospital coders have a more thorough understanding of operative details. Since most hospitals base their coding on physicians’ documentation, it is imperative that hospital-based physicians, such as many cardiothoracic surgeons, have an understanding of this transition. You will not have to change the language you use, but you many need to provide additional specificity in some areas of your documentation. Understanding ICD-10-PCS and appropriate changes to your operative and other procedure notes may decrease the need for coder queries to you.

It is important to note that physician professional services will still be reported using CPT (Current Procedural Coding) codes, so the way that you report your personal services will not change.

Costs of Transitioning
The estimated cost of transitioning from ICD-9-CM to ICD-10-CM is $22,000 per physician. These costs are associated with the following:

1) Updating your information systems, which may include practice management systems, electronic medical records, and coding software;

2) Investing in the education and training of clinical and administrative staff, including internal and/or external auditing of current documentation and processes, training courses for key personnel, and the development of crosswalks or maps to facilitate certain functions in the office;

3) Staffing and overtime to accommodate implementing a new coding system on top of current responsibilities. It is expected that there will be decreased productivity due to the learning curve before and after the transition; and

4) Updating and printing of communication sheets and other forms used in the office, if applicable.

Ideally, this transition will have minimal impact on physicians, but since that cannot be guaranteed, it is extremely important that physicians and their staffs be as prepared as possible. This means ensuring that all of your systems—internal and external, paper and electronic—are appropriately upgraded and that you and your personnel are adequately trained. It may be prudent to anticipate possible payment disruptions due to the transition. This may involve setting up a line of credit or putting money aside to cover any disruptions for 3 to 6 months.

STS plans to offer a series of ICD-10 webinars, as well as tools that will help cardiothoracic surgery offices with this transition. Visit www.sts.org/advocacy/coding-reimbursement-corner for more information.