What do “Sucked into a jet engine, subsequent encounter” (V97.33XD); “Walked into a lamp post, subsequent encounter” (W22.02XD); and “Animal rider—injured in collision with a streetcar” (V80.730A) have in common?

You’d be correct if your answer was, “Those are all weird situations!” But, if you answered, “They’re all seven digit ICD-10 codes,” you’d also be correct.

As hard as it might be to believe, these strange occurrences are all legitimate ICD-10 codes, according to our office’s EHR advisor. Such oddities have even spawned a parody of sorts, an art book/series called Struck by Orca (in honor of code W56.22XA).

Most likely, everyone reading this now knows that ICD-10 stands for the International Classification of Diseases, 10th edition. ICD-10 was first introduced in 1999 with some 30 countries now using the codes. Currently, we are the only industrialized nation not using ICD-10.

Now, having been delayed for a year, its implementation starts—ready or not—on October 1, 2014.¹

Why it Matters
ICD-10 is a standard of coding that emphasizes “specificity” in carefully documenting a clinical visit. The old system, ICD-9, had 14,000 different codes; the new version will boost that number to more than 69,000 codes.

There are two key reasons for the change: (1) the older codes do not provide enough detail to assess claims to insurers, and (2) many of the old codes aren’t used any longer.

Some major changes between ICD-9 and ICD-10 that will affect your practice include specifying laterality in ICD-10 codes for most conditions and the use of a seventh digit in coding to reflect the severity of the condition. All ICD-10 codes start with letters. It’s important to note that CPT (procedure) codes will not be affected by the ICD-10 transition.³

Due to the new coding system’s “hyper-sensitivity,” practitioners run the risk of not being reimbursed—or worse, being audited—for their services. For example, using “unspecified” designation codes or not providing enough detail in the medical record for justification in using a particular code will likely result in not being reimbursed for services.^1-3 This will be key in submitting claims for general practices—and especially for those who provide specialty lens services.

Additional considerations in implementing the new system include the super-bill and billing services. A digital system (EHR/EMR) will be required for ICD-10 coding for a comparable patient profile. ICD-9 conversion to ICD-10 codes by a billing service is nearly impossible, as they will not have access to all the medical records or the provider’s judgment. This will invariably result in the submission of erroneous information to the payer, as well as reimbursement denials.⁴

To transition effectively from ICD-9 to ICD-10, it is essential that practitioners take full advantage of every available resource. The experts recommend using all chapters in the ICD-10 coding book—not just the eye-related Chapter 7.¹ It’s important to tie in the systemic components as well. Another new support aid is the software-based conversion tables that allow users to enter the old ICD-9 code and get an idea of the coding area for ICD-10.¹

Be prepared to hit some snags at implementation date. Remember, all HIPAA-covered entities will require ICD-10 codes. Initially, you’ll likely encounter a dramatic increase in claims denials. So, take full advantage of the resources of your payers’ and vendors’ clearinghouses, software/systems and billing services to ensure readiness for this change.

And, be prepared for what may lie ahead fiscally. CMS has stated the implementation of the new code set will move forward without another delay, despite some reports that small practices and systems are not ready for the change.² On October 1, 2014 there will only be limited code set updates for new technologies and diagnoses.³

So, is there a code for that patient you just examined? Probably, seeing as we have one for hitting a lamp post or getting sucked into an engine. I’m just relieved to know that I have an option if there’s a collision with a streetcar.

Happy coding! I can’t wait for the next series, ICD-11!

1. http://www.revophth.com/content/c/44880/.
2. http:/www.medscape.com/viewarticle/817971?nlid=450.
3. J. Rumpakis, Practice Resource Management, Inc. www.PRMI.com.
4. IMS Tutorial 03 for Ophthalmology, 2014.