ICD-10 Is Coming Up Fast: The Best Way to Make the Change

Betsy Nicoletti, MS


December 11, 2013

In This Article


The International Classification of Diseases, 10th Revision (ICD-10), will go into effect on October 1, 2014, and doctors, hospitals, and payers will be affected by its implementation. Many large groups and hospitals already have ICD-10 implementation plans in place and are far along in training and workflow analysis, but smaller hospitals and independent physician groups are much less prepared. Yet, 100% of practices are expected to transition to ICD-10 diagnostic codes.

So much of the advice that physicians read seems like fear-mongering, a sales pitch, or simply generic. The doctor and office manager are stuck wondering, "What am I supposed to be doing right now to prepare for ICD-10? Anything? Or should I wait?"

About one half of medical practices currently use an electronic health record (EHR); some practices use an EHR to enter charges and order tests, and a large number (especially those that began using an EHR only recently) still use a paper encounter form to indicate what services were performed and what diagnostic tests and referrals are needed, and why. The "and why" -- the conditions, symptoms or indications that necessitated the encounter, referrals, and tests -- is significant in the transition to ICD-10.

Your next steps in implementing ICD-10 will depend on how your practice currently selects diagnosis codes for charge capture and orders.

If You're Using Paper Records and Encounter Forms

Medical practices using paper medical records typically also use a paper encounter form. In most cases, the physician or other clinician sees the patient and then circles the service provided using Current Procedural Terminology (CPT) codes, and the diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), codes, typically listed on the claim form.

Hopefully, the physician rank-orders them by writing "1," "2," or "3" next to each code, so that the staff member doing charge entry knows the order in which to enter the codes on the claim form. If a diagnostic test is ordered or an immunization is given, the clinician may link the service with the covered diagnosis by an arrow or line connecting the two.

Physicians often find these forms efficient and effective. However, as a result of significant space limitation on paper encounter forms compared with the number of most commonly used diagnosis codes, these forms will be inefficient and ineffective with ICD-10. Specialties that do not have a significant number of diagnosis codes, such as psychiatry, may not have this problem. However, for such specialties as general surgery, primary care, and orthopedics, this presents a significant challenge.

The encounter form may have several unspecified codes, to make room for as many as codes as possible. The medical record documentation may support a more specific code, but that is not selected on the paper encounter form or reported on the claim form. However, in ICD-10, where specificity is important, the unspecified code may not support the medical indications for the test or procedure.


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