Even more ICD-10 codes on their way

Last October, ICD-10 was implemented with 68,000 new codes included, and when it was first rolled out, there was much controversy surrounding it. Many people protested the conversion because it was costly to implement and a further time drain on already time-challenged practitioners.

Eventually, the kinks were worked out and the medical community started to adjust.

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Now, it has been announced that the Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services (CMS) will be adding 1,900 additional diagnostic codes and 3,651 hospital inpatient procedure codes to ICD-10 for fiscal year 2017.

The high number of proposed new codes is associated with clarification of the ICD-10 codes initially implemented, as well as additional codes for new technologies and diseases, says Cedrial Moore, RHIA, American Health Information Management Association approved ICD-10 trainer and ambassador.

“As of March 9, the proposed code revisions include approximately 1,900+ new diagnosis codes and 3,600+ new inpatient procedure codes, including approximately 500+ procedure code revisions,” says Moore, who is also AVP, revenue cycle at Quorum Health Resources, LLC, of Brentwood, Tennessee.“These additions and revisions are greater than the average number of codes revised annually. Final code updates will be published in June.”

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Cardiologists and cardiovascular surgeons will be greatly impacted by the number of inpatient procedure code updates and Moore anticipates that many of the 1,900+ new/proposed diagnosis codes will affect internal medicine and family practitioners as well.

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More coding than care

Linda Girgis, MD, FAAFP, is a family doctor in private practice in South River, New Jersey, who does much of her own billing. She is among many clinicians who feel the new codes are not needed. As a family practitioner, Girgis sees a whole host of diseases but with more than 70,000 codes in total, there’s no way she can memorize all she needs to know.

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“It now requires me to look up codes every single time and this takes time. I sometimes spend more time trying to figure out the right code to the highest degree of specificity than I did with the patient,” she says. “So, the new coding system is very burdensome to family doctors.”

The new diagnosis codes will be included in CMS’ Hospital Inpatient Prospective Payment System proposed rule for FY 2017 scheduled to be released in June 2016, allowing more time for providers to prepare. New generation technologies that can ingest the new codes will be critical in ICD-10 compliance success, as well as achieving financial, operational and quality care goals.

“Healthcare providers must continue to implement ongoing strategies to update documentation tools, provide documentation and coding education and manage revenue cycle procedures,” Moore says. “Ongoing payer communication will continue to be a challenge for providers as new codes may result in new payer authorization, documentation and reimbursement procedures.”

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What doctors should know

Physician coding educator Betsy Nicoletti, MS, CPC, says the key thing for practitioners is to have a software system that lets physicians search easily. For internal medicine, family medicine providers and cardiologists, this means making sure you and your staff are entering information accurately.

“I would make sure my physicians understood the risk-based adjusted diagnostic coding and make sure they are looking at their own specified codes and documenting and submitting claims correctly,” she says. “More than 90% of the ICD-10 procedure code updates are related to inpatient cardiology and cardiothoracic procedures. Cardiologists and cardiovascular surgeons will need to continue to document the specific approach, vessels included and any implanted materials or devices for cardiovascular procedures to support assignment for the new codes.”

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Judy Waltz, JD, a healthcare partner of the San Francisco office of national law firm Foley & Lardner, notes that while she’s sure that providers will cringe at the idea that an update is necessary, and there will be even more new codes to be learned, overall, it seems like most in the medical community have survived the transition to ICD-10 without too much difficulty. 

“There are a few months before the new codes will be in place, giving people time to digest and come up with an action plan as to how to integrate these new codes,” she says. “The ‘need’ for new codes is to be as precise as they can be. The U.S, in using ICD-10, is already behind some other countries, which are using ICD-11. There is a process where new codes can be requested by outside parties, and the meeting notes show that some were requested.”

To not get left behind, all providers should review their progress post-ICD-10 implementation, identify key risks and implement action plans to mitigate documentation, coding, reimbursement and revenue cycle risks.