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