May 16, 2011

ICD-10: Myths: Fact or Fiction

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As to be expected with any wide sweeping change there will be misconceptions and ICD-10 is no exception.

 

We have compiled a few of the more pervasive myths in an attempt to help set the record straight and assist you in planning for the transition to ICD-10.

 

True or false, CMS is expected to push back the compliance deadline from October 1, 2013 to October 1, 2015, essentially providing a two- year delay.

(F)

 

True or false, CMS will accept ICD-10 codes prior to the mandatory compliance date if providers are ready to begin submission.

(F)

 

True or false, ICD-10-PCS codes will be reported for all inpatient procedures and all professional fee services provided in the inpatient setting.

(F)

 

Professional fee services provided in the inpatient setting will be reported with CPT® codes.

 

True or false, the time to begin in-depth ICD-10-CM/PCS coding training is now.

(F) Only awareness and biomedical skills training should be provided prior to 2013.

 

True or false, ICD-10 requires the submission of electronic claim forms, so all coding must be done electronically and not by book.

(F)

 

CDS/CIS will need to learn how to code in order to work with ICD-10 codes.

(F)

 

True or false, like many other healthcare initiatives, ICD-10 will be phased in over time with hospital providers requiring compliance on October 1, 2013 and physician providers requiring compliance on October 1, 2015.

(F)

 

True or false, ICD-10-PCS will replace all levels of HCPCS codes

(F) HCPCS codes, including CPT, will continue to be used for all outpatient services.

 


 

True or false, ICD-10 will not be implemented in the United States because ICD-11 is near completion and will provide even more benefit.

(F)

 

True or false, with ICD-10 non-specific codes are no longer available for use and therefore a CDI program is required to obtain the necessary documentation to avoid delayed claim submission.

(F)

 

True or false, ICD-10 is so specific that the number of clarifications or queries will increase 5 fold.

(F)

 

True or false, the sheer number of codes available for assignment in ICD-10-CM/PCS makes it very difficult to use and therefore necessitating computer assisted coding and use of encoder software to assign codes.

(F)

 

True or false, the HIPAA mandate to transition to ICD-10 is only applicable to providers. Payers will be able to choose between paying based on ICD-9-CM or ICD-10-CM/PCS.

(F)

 

True or false, the coding guidelines applicable to ICD-10 will be the same as those used to code in ICD-9-CM.

(F) No, chapter specific coding guideline changes are already apparent.

 

True or false, there are 20,000 ICD-10-PCS procedure codes as compared to 4,000 ICD-9-CM procedure codes.

(F) There are 71,957 in ICD-10-PCS 2011 version.

 

True or false, the official coding advice in Coding Clinic, published by the American Hospital Association since 1984 will still be applicable to coding in ICD-10.

(F)

 

True or false, the transition to ICD-10 is required only when billing Medicare, not state Medicaid programs.

(F)

 

True of False, the federal government can and will levy fines on those entities that are not compliant with the final ICD-10 go live date.

(T)

 


 

True or false, non-compliance with ICD-10 will be similar to what was encountered with non-compliance with HIPAA, you will still be paid, but may have to pay fines if not compliant.

(F) There will be no Medicare payment for non-compliance under ICD-10.

 

True or false, after the transition to ICD-10, ICD-9-CM will no longer be maintained.

(T)

 

True or false, the assignment of ICD-10 codes requires greater knowledge of anatomy and physiology than was required with ICD-9-CM.

(T)

 

True or false, the transition to ICD-10 is expected to negatively impact coder productivity.

(T)

 

True or false, the transition to ICD-10 is expected to worsen the current coder shortage.

(T)

 

True or false, much of the detail found in ICD-10-CM diagnoses codes is currently already found in medical record documentation, but not required by ICD-9-CM.

(T)

 

True or false, ICD-10-CM for diagnosis reporting is very similar to ICD-9-CM, however, ICD-10-PCS for procedure reporting is very different from ICD-9-CM procedure coding.

(T)

 

True or false, although General Equivalence Mappings exist to translate ICD-9-CM codes into ICD-10-CM codes, providers will still need to be able to assign codes using native ICD-10 codes.

(T)

 

True or false, ICD-10-CM/PCS was designed with considerable input by physician specialty associations.

(T)

 

True or false, the transition to the 5010 was necessary before ICD-10 codes could be submitted.

(T)

 


 

True or false, the General Equivalence Mappings (GEMS) developed by CMS are applicable to all payers not just Medicare.

(T)

 

True or false, the current 2011 version of ICD-10-CM/PCS is in draft form only and subject to change prior to implementation.

(T)

 

True or false, there are 69,368 ICD-10-CM diagnoses codes as compared to 13,500 ICD-9-CM diagnoses codes.

(T)

 

True or false, the average age of the typical hospital inpatient coder is 54, adding to the concern that there will be a shortage of experienced coders available to assist with the transition to ICD-10 coding.

(T)

 

True or false, the majority of additional diagnoses codes found in ICD-10-CM can be contributed to the ability to capture specific anatomical sites, and report laterality and episode of care.

(T)

 

True or false, when assigning an ICD-10-PCS procedure code there is no requirement to utilize the Alphabetical Index first, prior to referring to the procedure tables in the Tabular List.

(T)

 

True or false, providers will not reap the full benefit of ICD-10 without a robust clinical documentation improvement program in place.

(T)

From the time ICD-10 was ready for adoption, in 1990, there have been many myths perpetuated about the new classification system. We hope this helps debunk some of those prevailing myths.

 

About the Author

 

Angela Carmichael, MBA, RHIA, CCS, CCS-P, joined J.A. Thomas & Associates in 2008. She is a HIM Product Development Specialist specializing in clinical documentation improvement, coding education & reimbursement methodologies. Angela earned a Bachelor of Science degree, in Health Services Administration from Barry University and a MBA from Nova Southeastern University. She is a Registered Health Information Administrator and also has achieved the designations of Certified Coding Specialist, and Certified Coding Specialist-Physician and AHIMA Approved ICD-10-CM/PCS Instructor.

 

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Read 60 times Updated on September 23, 2013