Monday, August 1, 2011

I Love ICD-9-CM - What if I Don't Feel the Same Way About ICD-10?


I think there are a lot of students out there learning ICD-9-CM right now who are feeling a certain apprehension about the ICD-10 implementation. It's a tricky time to be educated in coding right now - you may decide you love ICD-9-CM only to have it ripped from your grip in 2013 and replaced by something that doesn't closely resemble your new found love. So maybe you've been reconsidering a field in coding.

Well, let's not overreact! First of all, let's look at what it is you like about coding, what will be changing, and then decide if it's time to overreact!

First of all, ICD-9-CM, Volumes 1 and 2 (the diagnosis codes) are being replaced by ICD-10-CM. And although there are some tricky areas and all of the code numbers are different, the overall feel and use of ICD-10-CM is not that dissimilar to what we're used to today. Yes, it will be more difficult to roll codes off the top of our heads like many of us can now with ICD-9-CM, but it will not be impossible (after a week coding in ICD-10, I found it was not difficult to memorize frequently used codes. The major changes? We have extensions now to indicate the episode of care for patients with injuries and we have codes for underdosing of medications - something that's completely foreign. And although in ICD-10 there are two types of excludes notes instead of one (not coded here vs. not coded in addition), that's a nice change that most coders are happy about.

ICD-10-PCS on the other hand, is very different from Volume 3 of ICD-9-CM, which includes procedures. In fact, ICD-10-PCS is very different from anything we've ever used for coding. The fact that there are no inclusion and exclusion notes - no tabular listing, in fact - only pages of tables, makes it seem daunting. This will be a huge impact, no doubt.

But should you worry about it? Remember - ICD-10-PCS has limited application. It is only required for billing on hospital inpatient claims. So if you work for a physician - or plan to - you will not have to learn ICD-10-PCS. If you code outpatients in a hospital, the jury is still out. Many hospitals still collect ICD-9-CM procedure codes for outpatients so they can use the data internally (remember - coding is about data collection too, not just billing). There is much discussion in the industry on the productivity impact of having coders code in both ICD-10-PCS and CPT for hospital outpatient services.

CPT is not at all affected by ICD-10 implementation. If you code for a physician, you will continue to use CPT to code and bill for his services and procedures.

Of course, if you find you have an affinity for ICD-10-PCS, perhaps this will help you determine your career path and you can look for opportunities to code in a hospital. Inpatient coding is usually a higher level coding position, so it may take time to get promoted up, but if you have the skill for ICD-10-PCS, it's my belief that you will be in demand. I think some current inpatient coders may decide they don't care for ICD-10-PCS at all and make some changes in their career paths.

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