How physicians can prepare for the new ICD-10 codes

New ICD-10 procedure and diagnosis codes-added as a result of the thawing of a partial code freeze in effect since 2011-are coming October 1. The new codes continue the trend started with ICD-10 implementation to provide greater specificity, telling an even better patient story and keeping pace with ever-changing demands for health information.

While the number of ICD-10 code updates related to the five-year code freeze can seem daunting, the majority of the changes and additions are minor. For example, approximately 61% of the new and revised codes pertain to laterality, so the effect on training and education of staff is reduced. In fact, the proposed codes are the result of requests and recommendations from physicians and others in the healthcare community. 

After reviewing public comments on the proposed codes, the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) released the final addenda for the October 1, 2016 code updates in June. The preliminary list contains approximately 1,943 new, 305 deleted and 422 revised ICD-10-CM diagnosis codes.

Reasons for the code freeze

The partial code freeze was instituted in October 2011 to facilitate the ICD-10 transition by stabilizing the code set while systems changes, education and other preparations were underway.  

The partial freeze stipulated that, until one year after ICD-10 implementation, only limited annual code updates would be implemented so as to acknowledge new technologies and new diseases.  

Getting ready for additional codes

Physician practices should review both the alphabetic Index and the tabular list of the final addenda released in June. There are frequently changes to how conditions are classified (in the index) that may result in a different code, but not necessarily a new code.

For example, a diagnosis of bacteriuria would be assigned N39.0 on September 30, 2016, and R82.71 on October 1, 2016. As with any code update, healthcare professionals will need to revise reference sheets and stay in touch with their vendors to ensure electronic health record (EHR) and billing software are updated and tested before October.  Provider and staff education regarding changes is also critical to prevent claim denials and keep the transition running smoothly.

Providers should review the list of new, revised and deleted codes that is available on the Centers for Disease Control and Prevention and CMS websites; they can then easily compare their practice area’s most common codes with the proposed code updates. They should also note any changes that add specificity to conditions, such as the example below of laterality in eye conditions.

Another best practice would be to check with vendors to ensure that their EHR system is updated and correct. If super bills are still being used, they will need to be compared against the code updates and adjusted accordingly. 

For practices using a single system for EHR and billing, another tip is to ensure that each billing system has updated codes and code edits/scrubbers to ensure the release of a clean claim.  If using a clearinghouse, the practice also needs to see that the clearinghouse has taken appropriate steps to ensure compliance with the updated codes and code edits.