Ensuring Provider Payment While Transitioning to ICD-10

BY LAUREN DEWITT AND BRAD BALDWIN W ith little more than a year before the mandated shift from the International Classification of Diseases, 9 Revision, (ICD-9) to the International Classification of Diseases, 10 Revision, Clinical Modification and Procedure Coding System, (ICD10-CM and ICD-10-PCS, respectively), on October 1, 2014, all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) subject to this change find themselves at a challenging convergence of technology, heightened regulatory scrutiny, and increased specificity of professional documentation. The necessity of preparation cannot be understated, for potential negative economic repercussions to underprepared health care providers pose a very real threat. The increased specificity in documentation of care provided has been a highly touted aspect of the implementation of ICD-10-CM and PCS. Perhaps no better illustration of this fact is a comparison of the number of codes contained in ICD-9-CM and those to be implemented with ICD-10-CM and ICD-10-PCS. Where ICD9-CM contained approximately 14,000 code variations, ICD-10-CM contains approximately 69,000 diagnostic codes, and ICD-10-PCS has approximately 72,000 codes, which collectively include, among other distinctions, gender specific coding, anatomic specific coding, laterality coding, and inpatient hospital specific coding.