Urgent: ICD-10

Are you hoping that the transition from ICD-9 to ICD-10, currently scheduled for October 1, 2014 October 1, 2015, will be delayed for the third time? Well, it is looking more and more like this dream will not become a reality. It is time to get your encounter forms/charge tickets/superbills updated to the new ICD-10 codes. As you know from our previous blog post on ICD-10, the number of diagnosis codes is going to increase from 14,000 to almost 70,000.

So what do you need to do to get ready for this earth-shaking change? As you can imagine, with the addition of 56,000 diagnosis codes and the added complexity for all codes, your current single-page encounter forms/charge tickets will be a thing of the past; there is no font small enough to fit them all on one page. You will likely have an increase of 2-4 pages for every charge ticket you have, even with expert formatting. You will need to reconsider which diagnoses your practice uses the most, and choose appropriate ICD-10 codes to use in updating your encounter forms. The AAPC has a great website resource that helps with finding ICD-10 codes.

As you choose ICD-10 codes for your new encounter forms, be very aware that there is no such thing as a crosswalk from ICD-9 to ICD-10. Even the General Equivalence Mappings (GEMs) from CMS are not a true crosswalk. Not only is ICD-10 incredibly more complex than ICD-9, it also uses a completely different organizational system in some areas.

Making a change on your encounter form like the one from ICD-9 code 649.51 (spotting complicating pregnancy) to the three equivalent ICD-10 codes O26.851/O26.852/O26.853 (depending on which trimester) is easy, although it will clearly require more room on the form. Not one-to-one but we can deal with this, right?

Wait till you get into wounds, though! ICD-9 uses the term "complicated open wound," which can indicate complications of a foreign body, infection, delayed healing or delayed treatment. But in ICD-10, a wound is either a puncture or a laceration, with a foreign body in it or not.  Delayed healing and treatment don't come into it at all, and infections require you to add a separate code! This will involve reorganizing your encounter form.

This combination of greater specificity and total reorganization can lead to staggering statistics when attempting to map one system to the other. There is one ICD-9 code (733.82) that corresponds to 2530 ICD-10 codes. Let me say that again. 2530! This is not a one-to-one match. Understand that the GEMs do not help you to find the ICD-10 code corresponding to previous ICD-9 code. Rather, they help you find the best re-diagnosis under the new system. Consequently, if your new encounter form looks exactly like the old one, but with new codes, it will almost certainly lead to errors in coding and misdiagnosis. Using the pregnancy example above, 649.51 does indeed translate to O26.852, but if that is the only option available on the encounter form, without considering O26.851 and O26.853, you will have serious coding mistakes, with every patient coded in her second trimester of pregnancy. A good ICD-10 encounter form, because of the fundamental difference between the systems, will have new descriptions and more selection, but still cover the diagnoses your practice will use most frequently.

Don't fear: Though this transition should not be underestimated, it can be made! If your encounter forms are generated through the Rexpert System, we will create your new one. Once you've selected your new organization and ICD-10 codes, just send those in to us, requesting them on a new encounter form. As a bonus for the practices that want to be ahead of the game, we will create the new document for free as long as we receive your edited form(s) by May 1, 2014 June 30, 2015. After that deadline, we will create a new document for you for $100 a form. This price may increase as the ICD-10 changeover looms closer, and there will be a final cut-off date after which we can no longer accept requests. Contact Client Services for more information on this promotion and for details on how to get started.


Contributors: Christine Parker, Mel Johnson, and Laura Rowe.

ICD-10 Testing

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

In our last blog post, we discussed the urgency around getting all encounter forms ready for the ICD-10 changeover in October. This week, we would like to tell you about some of the testing that we've done on our end to ensure that we will be ready for the change as well.

In August 2013, GVT did several ICD-10 test-claims to Emdeon. All of these tests came back successful; we received the normal processing reports back that the claims were accepted and approved. However, the test results had very limited feedback other than the test success. We did not receive the payor response and we are working with Emdeon to send more ICD-10 tests when the payor feedback will be available. 

Additionally, in the first week of March 2014, GVT sent several ICD-10 tests to Medicare and all results were successful as well. It was a similar scenario to Emdeon testing where we received back the normal reporting that the claims were accepted and approved. Per Medicare EDI, that feedback is all that is offered at this time.

In July 2014, Medicare testing will continue and data will be exchanged at both ends more extensively. GVT will send the ICD-10 test claims and Medicare will send back actual EOBS/remittance advice for those test claims to Rexpert. If practices would like to volunteer for testing, they will need to fill out this form here: https://www.surveymonkey.com/s/TWL6WRT by March 24, 2014. Medicare will be selecting practices based on their own testing needs, so it is possible that none of our practices will be chosen. If Medicare chooses your practice for ICD-10 testing in July 2014, please contact GVT client services.


Contributors: Christine Parker and Mel Johnson

ICD-10 Updates

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

Are you ready for more ICD-10?! Don’t worry; we’ve passed the boring, basic, background information. It’s time to move on to the practical side of the ICD-10 implementation in Rexpert. If you have been following along with our ICD-10 blog series, then you will remember that Rexpert will follow a sequence of phases during the ICD-10 implementation. There will be two testing phases (to be done prior to 10/1/14 10/1/15) and the live phase on October 1, 2014 October 1, 2015. You will be expected to participate in the testing phases and provide feedback to Client Services on any errors or issues that occur during testing.

Now, so as not to bombard you with too much information all at once, we will save details on the testing procedures for a later blog post. To prepare you for the upcoming testing, it’s best to first become familiar with the testing parameters. So, today I will be guiding you through some of the updates that will be were made to Rexpert during the September 2014 release.

There are three important areas to be aware of while transitioning from ICD-9 to ICD-10. These fields will be used during both the testing phases as well as the actual live phase on October 1, 2014 October 1, 2015. Warning: These pictures are for reference ONLY. Do NOT change the settings of the fields in these pictures without first coordinating with Client Services.

System Options

The ICD-10 Starts On field has been added in R10. This date is set by Client Services and dictates the day on which a practice will transition to ICD-10. Access this field through Settings > System Options, Main Tab.

Charge Entry

Within the database, each charge will be internally and automatically marked to indicate whether it uses ICD-9 or ICD-10 diagnosis coding. All charges entered after the ICD-10 start date (mentioned above) will be coded as ICD-10. However, all charges entered prior to the ICD-10 start date will still be set to ICD-9. To create a smooth transition, Charge Entry has been updated to automatically adjust the diagnosis browse to display the correct code set. If a charge is set to ICD-10, the diagnosis browse links to the ICD-10 code list and [vice versa].

Payor Options 2 Tab

Individual payors can be set to accept ICD-10, ICD-9, or both by editing the new ICD version(s) accepted by this payor option that will be added to Rexpert in September. Access this options through Settings > People and Places > Payor, Payor Options 2 Tab. If a charge has been created using ICD-10 but the payor is not yet ready to receive ICD-10 claims, the GEMS ICD crosswalk will be used to translate the ICD-10 codes to ICD-9. The ICD translation takes place during the billing extract and the charge maintains the diagnosis codes entered by the user.

Keep these updates in mind when you check out our upcoming posts on Testing for Emdeon. And don't forget: September 30, 2013 is was Rexpert Release 10 and October 1, 2014 October 1, 2015 is the compliance date to implement ICD-10. If you have any questions about these new options, contact Client Services via the Feedback button or leave a comment below.

ICD-10 vs. ICD-9

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

Last week's post, Introducing ICD-10, was a very short introduction to the new ICD-10 code system that will be required in 2014 2015. Since the transition from ICD-9 to ICD-10 is major and requires multiple steps, it will be hard to put such a massive amount of information into one post. So, for the next few weeks, we are going to be dedicating posts solely to informing you of all aspects of ICD-10.

In our entry last week, we outlined tips for designing an ICD-10 implementation plan. Please know that this is something only you can set up with your practice. We cannot create a plan for you! However, Client Services will be happy to serve as a reference if and when you have a question. This and future posts are also meant as references to help with the process of designing and executing your plan.

Now that you have been introduced to ICD-10, this week we will cover:

• The history of ICD-10
• The benefits of ICD-10
• The major differences between ICD-9 and ICD-10 coding

According to the ICD-10 Official Guidelines for Coding and Reporting, "the ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings." Originally adopted in 1990 by the World Health Assembly (WHO), the official compliance date for transferring to ICD-10 diagnosis codes will be on October 1, 2014 October 1, 2015. The compliance date was initially set for October 1, 2013, but has been delayed to next year and then delayed yet again! With 2014 fall 2015 fast approaching, it is time to start preparing for the transition.

A good start is to know how the ICD codes have changed from version 9 to 10. ICD-10 diagnosis codes have been designed to enhance the world of medical coding in several ways. According to ICD-10 trainer DeLinda Ross's presentation, ICD-10-CM At A Glance, ICD-10 codes "provide more clinical detail and specificity", promote a better quality of coding and documentation, and "provide better data for research quality measurements, and setting health policy". Already, ICD-10 sounds like a vast improvement to ICD-9, right? With more specificity and less margin of error, doctors will be able to better communicate between each other for the benefit of the patient.

These benefits manifest themselves in the changes to ICD-10 coding. These changes include:

• The addition of two characters: Whereas ICD-9 codes contain 3 to 5 character per code, ICD-10 codes contain 3 to 7 characters.
• Example: XXX.XXXX = 7 character code
• Note: all codes must be at least 3 digits and a decimal separates the 3rd and 4th characters.
• The placeholder x : for codes using the 7th character, but not the 5th or 6th characters, x can be used to mark the character's place in the code without giving it a value. 
• Example: T75.4xxA = electrocution, shock from electric current, shock from electroshock gun (taser), initial encounter
• 7th character defines encounter: 
• Initial encounter
• Subsequent encounter
• Sequela
• Combination codes: include conditions, symptoms, and/or manifestations. These are defined by parenteses or brackets.
• Example: T360x1D = poisoning by penicillins, accidental (unintentional), subsequent encounter
• Laterality: pinpoint which side of the body has the condition
• Example: left hand, right shoulder, left ear, right lung, etc.
• Timeframes: removing the 5th digit in a code indicates episode of care/trimester for OB codes
• Example: O99.013 = anemia complicating pregnancy, third trimester

The ICD Codebook has experienced some changes as well. Whereas the ICD-9 codebook had 17 chapters, the codebook for ICD-10 diganosis codes now has 21 chapters. Many of those chapters have been reorganized. For instance, eyes and ears now have their own chapters rather than being grouped with the nervous system. In addition, "chapters are organised by body or organ system or by etiology or nature of the disease process" (Ross). From there, each chapter is then divided into subchapters. 

Note: The list of changes to ICD-10 diagnosis codes goes on, but cannot be covered in a short blog post. The ICD-10 Official Guidelines for Coding and Reporting contains the complete list of changes.

More information about ICD-10 is sure to follow, so keep an eye out for next week's post on Testing.

Questions? Concerns? We'd love to help! Just let Client Services know via the Feedback button. Also, if you know of any resources to help others, please leave a comment below.

Researched and compiled by: Kylie McKenzie Soder

Introducing ICD-10

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

Please take note of the following dates. They are very important. Write them on a sticky note, enter them on your calender, tattoo them on your arm... just don't forget!

September 30, 2013 - Rexpert Release 10.0

October 1, 2014 October 1, 2015 - Compliance date to implement ICD-10

The reason these two dates are important and so intimately connected is a simple one: we will all be required to switch our diagnosis codes from ICD-9 to ICD-10 on the second date. Rexpert's next release, on September 30, 2014, will provide is providing support for testing and compliance.

This change is going to be tough, but Rexpert will be going through a series of phases over this next year to create a smooth transition for everyone. Each practice should develop a plan for this period.

Some things to consider while designing a ICD-10 implementation plan are:

1. Training: What training must your providers and internal staff go through so that your practice is ready to code services using ICD-10? If you need resources for such training, use the Feedback button to request assistance, so that we can point you to sites and programs suitable for your specialty.
2. Interfaces: Does your practice use other software that interfaces with Rexpert? Please double-check that this software is set to transition to ICD-10 on the same date as Rexpert. For example, if it is a hospital system, this may determine the date that Rexpert is switched for your practice.
3. Electronic Health Record (EHR): If an Electronic Health Record is available, will the EHR do the coding? What is the ICD-10 update schedule? There will be similar issues with coordinating dates.
4. Internal Documentation: What updates need to made to your patient documentation, encounter forms, and/or charge tickets? Plan on your encounter forms to at least double in length and significantly change in character. Some estimates place an ICD-10 encounter form at 4-5 pages. These changes, especially, need to be worked out well in advance, since it will be impossible to convert everyone's forms starting on September 15, 2014 September 15, 2015! We can develop your new forms and place them "to the side" in your system where they will be ready for the transition date. Rates for this service will increase as the final deadline approaches, so make sure to plan ahead.
5. Test Billing Processes: This is so complex that it is best left for a later week's post!

Here's a chance for you to help your fellow users. Please leave a comment about what you've done so far to get ready for this transition. What challenges are you facing? Have you found any good resources? What is a good first step for a practice which has so far done nothing? Thank you!


Written by: Kylie McKenzie Soder