The impending transition to ICD-10 has caused quite a stir among medical professionals, politicians, and news personalities alike. With so many people talking at once, it’s tough to know who’s speaking the truth and who’s stretching it. Not to worry, though. Here, I’ll bust all the common ICD-10 myths clouding the airwaves and set the record straight once and for all.
Myth #1: There absolutely will not be another ICD-10 implementation delay.
Truth: Not so very long ago, we would have placed this “myth” in the truth category, because everyone—from CMS to HHS—was saying the transition would definitely happen October 1, 2014, regardless of whether medical providers and insurance carriers were prepared. And then came HR 4302. Originally drafted as the 2014 Sustainable Growth Rate “fix” bill, this piece of legislation somehow came to include a provision to delay the mandatory ICD-10 implementation deadline at least a year. (According to Sharon Canner, senior director of public policy of the Ann Arbor, Michigan-based College of Healthcare Information Management Executives (CHIME), the fact that this is an election year probably has a lot to do with the last-minute ICD-10 delay making it into this bill.) So now, the earliest the US will make the switch is October 1, 2015.
Myth #2: To code correctly in ICD-10, coders will end up wasting hours upon hours sifting through thousands of ultra-specific cause codes.
Truth: Sure, the Internet is full of humorous nods to Chapter 20 of the ICD-10-CM Manual (External Causes of Morbidity), but while many external cause codes are good for a hearty chuckle or two—case in point: Struck by Orca—the truth of the matter is that in most circumstances, these codes are optional as there is no national requirement mandating their use. As explained in this Just Coding article, “…unless coders are already reporting external causes in ICD-9-CM (E000-E999), they are unlikely to have to start using them…This is because the use of external cause codes is voluntary unless required by a payer or state reporting mandate.”
Myth #3: ICD-10 is part of Obamacare.
Truth: As I mentioned above, ICD-10 was originally slated to go into effect on October 1, 2014. Calendar wise, that put ICD-10 in close proximity with the Affordable Care Act, which led many people to wrongly assume that the two were linked. Even national news outlets—perhaps most notably, Fox News—took media spin to a whole new level by erroneously referring to ICD-10 codes as “Obamacare codes.” I guess the fact-checker must have called in sick that day.
Myth #4: Once the switch to ICD-10 happens, ICD-9 will be gone for good.
Truth: While all HIPAA-covered entities—including most practitioners and payers—must change over to ICD-10, the ICD-10 mandate does not apply to non-covered entities such as workers’ compensation, disability, and auto insurers. Therefore, as Carl Natale writes in this ICD-10 Watch article, “If the non-covered entities don’t want to switch to ICD-10 coding, they don’t have to and can require healthcare providers to submit medical claims with ICD-9 codes.” But, as this EHR Intelligence article argues, it’s probably in everyone’s best interest to make the switch eventually because “the increased detail and specificity will be just as useful for worker’s comp as it is for the emergency department.” The article also mentions that CMS plans to work with non-covered entities and Medicaid programs to help them adopt ICD-10 codes and thus, avoid falling behind the rest of the healthcare world.
Myth #5: There’s a direct ICD-10 crosswalk for each ICD-9 code.
Truth: Everybody wants an ICD-10 easy button, and plenty of so-called ICD-9 to ICD-10 conversion tools have popped up to fill that demand. But while such tools can give you a good idea of where to start, they are by no means foolproof. Why? Because ICD-9 codes lack the specificity that ICD-10 codes offer. So for each ICD-9 code, there could be dozens—sometimes even hundreds—of possible ICD-10 equivalents. As such, automatic converters often will default to codes that do not represent the greatest possible level of specificity. And if you submit unspecified codes, you put your claims at risk for denial. According to Government Health IT, “University of Illinois Chicago researchers studied what happened when they applied a web-based ICD-10 converter to a bunch of ICD-9 codes. They lost information and potential reimbursements.”
So with conversion tools and General Equivalence Mappings (GEMs) off the table as standalone solutions, accurately translating ICD-9 codes into ICD-10 ones might seem like a tall order. Luckily, I’ve boiled the whole process down into five easy steps in this blog post.
Myth #6: ICD-10 codes will replace Current Procedural Terminology (CPT) codes.
Truth: It is true that ICD-10 includes a procedural code set (ICD-10-PCS). However, per CMS, this code set “will only be used for facility reporting of hospital inpatient procedures and will not affect the use of CPT.”
What other juicy ICD-10 gossip have you heard? Tell us in the comment section and we’ll let you know what’s fact and what’s fiction.