ICD-10 Conversion Overview & Recommendations
As everyone in the medical community is now aware ICD-10 is scheduled to take effect beginning October 1st, 2015 and at this time it appears highly unlikely any additional postponements of this change will take place. As such this article was crafted to provide a basic overview and actionable resources to assist healthcare providers that focus on the treatment and mitigation of Osteoarthritis of the knee adapt to this change in coding guidelines quickly and efficiently.
What is it?
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO).
What does it mean to my practice?
The transition from ICD-9 to ICD-10 will vary in complexity by practice type, scope, and location. For example surgical centers and hospitals will need to comply not only with the transition of new diagnoses codes, but also new procedure codes for most surgical and facility based procedures. Procedure codes are numbers or alphanumeric codes used to identify specific health interventions taken by medical professionals. That being said most outpatient facilities will only see these changes in diagnoses codes, and most procedures billed under the global fee schedule will not change.
How are procedure codes affected?
Procedure codes and their level of specificity are changing drastically with the conversion from ICD-9 to ICD-10, as there is no simple “crosswalk” and due to the increase in volume and type of diagnoses, so too must certain procedure codes be modified and new ones created altogether. To compare I-9 and I-10 code sets:
|ICD-9-CM||3-4 Numeric characters||~4,000 codes|
|ICD-10-PCS||7 Alphanumeric characters||~72,000 codes|
Again, these changes will be most complex and drastic in surgical and facility settings as I-10 will include specifications not only for the procedure being performed, but also the method such as Open (through cutting the skin) or Percutaneous (entry by puncture or minor incision to insert an instrument).
How to prepare?
The conversion from ICD-9 to ICD-10 is administered by a conversion system launched by the Centers for Medicare & Medicaid Services (CMS) called GEM. This acronym stands for General Equivalence Mapping and is a process by which an existing ICD-9 code is converted into one or more ICD-10 codes.
Some Electronic Medical Records (EMR) software platforms have built-in conversion software to assist the practitioner and billing staff in the conversion from ICD-9 to ICD-10. One such example is CareCloud, a web based practice management and billing software, that allows the provider and staff to enter ICD-9 codes and recommends the equivalent ICD-10 code, or group of codes from which to select. Most software platforms have some form of this assistive and training methodology built into their program, however they are all temporary measures designed to help the provider and staff assimilate into the new ICD-10 coding system which in most platforms will replace ICD-9 and deactivate the I-9/I-10 recommendation mapping feature at some predetermined time.
If your practice is not yet operating on an electronic charts basis code mapping will undoubtedly be more laborious. That said it is not impossible to map your practices GEM’s without the help of an EMR system. A free web based system I highly recommend to utilize as a tool is:
This web based tool allows you to enter a current ICD-9 code and then displays the codes new ICD-10 equivalent(s).
How will this affect payment?
While it is impossible to gauge exactly the economic impact the conversion from ICD-9 to ICD-10 will have on the medical community it is safe to assume that this process will result in some delays in processing medical claims as well as an increase in denials of claims, at least initially until both providers and payers become comfortable and proficient with this new operating basis.
That being said steps can be taken to minimize the potential adverse effects of this transitional period. My personal
advice to all is to closely monitor Local Coverage Determination (LCD) updates from CMS and Formulary changes from private insurance carriers. These documents not only define and advise how a procedure should be coded, submitted, medical necessity guidelines, and the like but they also list within them all acceptable ICD-9 codes as well as specific unacceptable ICD-9 codes if applicable. Many LCD’s and formularies have been updated to include ICD-10 codes, although many more including those for Viscosupplimentation, have not yet been published with ICD-10 updates in most regions.
CMS publishes a list of all Medicare Administrative Contractor (MAC) and their contract information for ICD-10 inquirers which you can find here:
I highly recommend if there are any “core services” your practice providers and you are uncertain of how the ICD-10 change will affect them that you email your jurisdictions MAC and request assistance accordingly.
ICD-10 Code Mapping for Osteoarthritis:
For those that we have assisted with the integration of The Advanced Arthritis Relief Protocol™ (AARP System) into their practices to offer non-operative alternatives to their patients suffering from mobility limiting diseases, the conversion to ICD-10 has a limited yet significant impact. As you are likely aware under ICD-9 the recommended primary diagnosis code for Osteoarthritis of the knee is 715.16 Osteoarthritis, localized, primary, lower leg. Submission of claims for payment of Viscosupplimentation without this diagnose code listed as the primary (first position) diagnose, and linked to all procedure codes provided on each date of service, commonly lead to non-payment of claims. One can assume that an equally strict policy will exist with the ICD-10 classification system, although it is not yet published on most LCD and Formulary documents at the time of publication of this article.
That being said we can prepare as best possible until specific guidelines pursuant to ICD-10 are published by our respective MAC’s nationwide. Below you will find a table of GEM’s as they relate to the most common diagnoses found in patients suffering from symptomatic Osteoarthritis of the knee(s):
One can assume that some of these ICD-10 codes will require the addition of modifiers to the linked procedural codes, as is currently necessary with ICD-9. I specifically theorize that M17.10 and M25.569 will require the addition of a Left (LT) or Right (RT) modifier to any linked procedure code as those codes do not specify which knee is involved. While we cannot be certain what the exact requirements of ICD-10 will be until they are published to our respective LCD’s and Formularies, we can do our best to plan in advance in an effort to minimize the potential economic impact of this transition.
Should you have additional questions or concerns, or to learn more about the advantages of offering The Advanced Arthritis Relief Protocol™ (AARP System) as a treatment option to your patients please contact Carlos Quiroga at 855-854-6332 or visit www.integrativepracticesolutions.com for a no-cost consultation (and some friendly advice).
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President-Integrative Practice Solutions
About the Author: Lance Liberti is a nationally recognized healthcare consultant and new patient marketing professional with more than a decade of practical experience in the field. His experience spans multiple areas of practice including non-surgical spinal decompression, medically supervised weight loss, aesthetic medicine, and non-operative extremity pain management. The president and CEO of Integrative Practice Solutions, Inc. Mr. Liberti specializes in assisting health and wellness professionals integrate boutique medical services into their practices to offer non-surgical solutions to those suffering from various degenerative musculoskeletal conditions. To learn more about Mr. Liberti’s extensive experience and see examples of his work products view his LinkedIn profile here: