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Acupuncture Today – November, 2013, Vol. 14, Issue 11 >> Billing / Insurance / Records

Implementing ICD-10 Coding: What You Need to Know

By Samuel A. Collins

The current system used for diagnosis coding in the in the United States is the International Classification of Diseases, 9th Revision, Clinical Modification (ICD9-CM), which was adopted in 1979.

This version is becoming obsolete, as it is does not meet the current and future demands of health care data needs. Therefore, there will be a change to adopt and use ICD-10.

However, this 10th revision is not scheduled for use until Oct. 1, 2014. Services billed on or after Oct. 1 will need the ICD-10 code set. ICD-9CM codes will not be accepted after this date. Bear in mind there is no early use or grace period for the change.

The ICD9-CM codes number about 13,000 and are numerical in value. They range from three digits to as many as five. ICD-10 has over 68,000 codes ranging from three to seven characters in length, with all having an alpha beginning. The code sets in ICD-10 are more specific and will allow a more exacting diagnosis.

The ICD-10 code sets are not a simple update of the ICD-9 code set. The ICD-10 code sets have fundamental changes in structure and concepts that make them very different from ICD-9. Because of these differences, it is important that acupuncture professionals develop a preliminary understanding and plan to implement the changes from ICD-9 to ICD-10.

Clearly acupuncturists (and other providers, for that matter) likely have never used or needed to use the 13,000 current codes of ICD-9, nor will they use the 68,000 codes in ICD-10. In actuality, about 5 percent of codes represent 70 percent of the coding for health care claims. But it is important to know the coding for the diagnoses that are commonly treated in your clinic.

A primary concern today with ICD-9 is the lack of specificity of the information conveyed in the codes. For example, if a patient is seen for treatment of an injury to the right arm, the ICD-9 diagnosis code does not distinguish that the injury is to the right arm. If the patient is seen a few weeks later for a different injury to the left arm, the same ICD-9 diagnosis code would be reported. As a consequence, additional documentation would likely be required for the claim to explain that the injury treated subsequently is a different injury from the one treated previously.

In the ICD-10 diagnosis code set, characters in the code identify right versus left, initial encounter versus subsequent encounter, sequela (chronic manifestations), and other clinical information, which allow for a much clearer definition of the condition.

Another issue with ICD-9 is that some chapters are full and limit the ability to add new codes. In some cases, new codes have been assigned to different chapters, making it difficult to locate all available codes. ICD-10 codes have increased character length, which greatly expands the number of codes available for use. With more available codes, it is less likely that chapters will run out of codes in the future.

The ICD-10 code sets are not simply an increased and renumbered ICD-9 code se,t and do not simply convert one ICD-9 code to a ICD-10 code. For instance, myalgia is currently coded in ICD-9 with 729.1, which is used for muscle pain (myalgia), but also has been interpreted to include fibromyalgia and myositis. In the ICD-10, there are separate codes: M79.1 for myalgia, M79.7 for fibromyalgia and M60.9 for myositis.

Shoulder pain in ICD-9 is 719.41, but in ICD-10 it is M25.519 for pain in unspecified shoulder, M25.511for right shoulder pain and M25.512 for left shoulder pain. Further illustrating the specificity of ICD10, instead of using a generic 729.5 for pain in the limb, there is M79.609 for pain in an unspecified limb, but also M79.603 for pain in an unspecified arm, M79.601 for pain in the right arm, M79.602 for pain in the left arm, M79.629 for pain in unspecified upper arm, M79.621 for pain in right upper arm, and M79.622 for pain in left upper arm.

Low back pain is a commonly covered diagnosis for acupuncture; the current ICD-9 code is 724.2. However, in ICD-10 back pain is M54.5, but also may include laterality when accompanied with sciatic pain: M54.40, low back pain with sciatica unspecified side; M54.41, low back pain with sciatica right side; and M54.42, low back pain with sciatica left side.

There will be codes distinguishing sprain versus strain, along with specific locations and muscles. Additionally, sprains and strains will have a seventh character, which will indicate if the visit is the first encounter (A), subsequent encounter (D) or sequela (S).

The move to ICD-10 will not be simple, as there may be as many 10 or more codes for a diagnosis where there was one generic code in the past. The ICD-10 code sets include greater detail, changes in terminology, and expanded concepts for injuries, laterality, and other related factors. The complexity of ICD-10 provides many benefits because of the increased level of detail conveyed in the codes. The complexity also underscores the need to be adequately trained on ICD-10 in order to fully understand reporting changes that will come with the new code sets.

Many publications and Internet-based resources will aid the acupuncture professional in this coding transition. Additionally, most major insurance carriers who cover acupuncture also publish allowed diagnosis codes in their acupuncture coverage guidelines, and will certainly include the ICD-10 coding set.

Each office should have at least one person in charge of setting up a transition protocol to be prepared for this update, as there is no transition period during which they will accept either code. At the very least, each office should be sure to convert its commonly used codes to ICD-10, bearing in mind there will be many more options and codes available.

Feel free to contact me if you have further questions about this process.

Click here for more information about Samuel A. Collins.


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