Scary stories from Canada, dire warnings from the American Medical Association (AMA), and a stream of experts alternately comforting providers and warning them to hunker down and prepare for the worst are leaving providers confused and conflicted a little more than a year before ICD-10 implementation on Oct. 1, 2014. In response to the jumbled avalanche of information hitting providers at a time when the industry is in the midst of several massive changes, the Centers for Medicare and Medicaid Services (CMS) has developed a fact sheet identifying several myths about ICD-10 and clarifying the truth behind these common misconceptions.

Myth: Not everyone has to switch to ICD-10.


All HIPAA-covered entities, including physicians and hospitals, are mandated to switch to ICD-10 in 2015. But that doesn’t include every single type of organization that currently uses ICD-9. Worker’s compensation and auto insurance companies, for example, use ICD-9 codes but are not required to make the leap to ICD-10. But it’s in their best interests to do so, says CMS, since physicians and hospitals will be using the newer codes. The increased detail and specificity will be just as useful for worker’s comp as it is for the emergency department, and CMS will work with non-covered entities to help them make the transition. State Medicaid Programs will also receive CMS help to ensure
that they will meet the deadline.

Myth: Everything is going to get prohibitively more complicated.

Fact: ICD-10 has a lot of codes

  • ICD-9 has 14,000 diagnosis codes, ICD-10 has 68,000
  • ICD-9 has 4,000 procedure codes, ICD-10 has 87,000
  • 140,000 total codes to be exact

But just as increasing the number of words in a dictionary doesn’t make it harder to use, the greater number of ICD-10 codes won’t significantly affect the complexity of coding, CMS explains. Electronic decision support tools and organized code books will make finding the right code easy, and the new logical structure of ICD-10 will help coders find exactly what they’re looking for.

Non-specific codes are still available for use if supported by clinical documentation, and much of the detail necessary for ICD-10 coding is already present. Providers do not need to perform unnecessary diagnostic tests just to get to the most specific code that exists in the code book. Superbills based on ICD-10-CM won’t necessarily be any longer or more complicated than ICD-9 superbills, and codes can be crosswalked to help the conversion process.

Myth: I can just use GEMs for coding medical records.


The General Equivalence Mappings (GEMs) are a handy tool for converting large amounts of data from ICD-9 to ICD-10, and are intended to help update payment systems, risk adjustment logic, quality measures, and research databases by mapping one code set to the other. They aren’t a one-to-one solution for coding an individual clinical chart. Mapping isn’t the same as coding, CMS warns, because the GEMs don’t allow for the selection of the most accurate and applicable ICD-10 GEMs are free of charge and available to any provider who wishes to use them, but code books, which are available in physical hard copies and electronic editions, should be used to deal with individual patient charts.

Myth: CMS is going to push the conversion date back again.


No, they won’t! CMS and HHS currently have no plans to move the date or extend the conversion process. Any provider who is not ready to use ICD-10 codes starting as of this date on October 1, 2015 will not be reimbursed for services performed on or after that date if they are coded in ICD-9. The one-year delay from 2013 to 2014 and now to 2015 has already caused significant disruptions in the planning process, but CMS has repeatedly said that the date will not budge again.

Providers should take advantage of CMS resources, such as detailed timelines and updated implementation guides, in order to plan their transition.

In the meantime, if you haven’t trained your coders to understand the new system, it’s time to get going.

For an overview of the complete ICD-9-10 Coding Training Course, read the syllabus here at: Coding Syllabus