March 12, 2014

What You Need to Know About Using ICD-10-CM in Physician Offices

Happy St. Patrick’s Day!  Even if you aren’t Irish, we could all use a little luck in dealing with the upcoming ICD-10 tornado that is due to hit in October 1, 2015. (revised date). If you haven’t started preparing, it’s time to hit the Fast Forward button and get going on your implementation checklist.   It seems most of the ‘panic’ calls we are getting are coming from physician practices who are just starting to understand this is going to represent a major change for them.   Working with Cavanaugh Consulting Group who is a business partner of H.I.Mentors, we have jointly developed the following ICD-10 facts to share with your medical staff who may be struggling with understanding the differences between ICD-9 and ICD-10 coding.  Call 708-352-3507 today to set up some Fast Track help with ICD-10 if you find yourself needing a little more than a lucky clover.


1. ICD-10 training in clinical documentation, NOT coding, is needed for physicians.

2. The documentation quality will determine if medical necessity and compliance are proven.

3. There is not a direct map nor one-to-one crosswalk from ICD-9 to ICD-10 codes. Many codes will require support from additional documentation in order to be assigned.

4. Choosing a non-specific code, as was often allowed under ICD-9, may not be accepted nor meet medical necessity if used under the ICD-10 system.

5. Coders can assign codes only if there is supporting clinical documentation from the physician. They cannot extrapolate or make assumptions.

6. The total volume of codes needed, per encounter, is expected to increase dramatically in many cases.

7. ICD-10-CM was designed to have clinical documentation performed by physicians and clinical coding performed specifically by coders using encoder software.

8. There may be a need to submit ICD-9 as well as ICD-10 codes for certain payors for a certain length of time.

9. ICD-10-CM is not designed to work with superbills or pick lists.

10. Ambulatory physicians who also see patients in a hospital setting will have different rules and guidelines regarding documentation for ICD-10-CM and because of the added use of ICD-10-PCS for procedure coding for hospital inpatients.

11. There will be different levels and methods of training to meet the ICD-10 educational needs for clinical staff, administrative/executive level staff, and coding/billing staff.