CM and PCS Changes
When practices track diagnoses using the ICD-9-CM system, they have approximately 14,000 codes to choose from, each of which are between 3 and 5 characters long. ICD-10 diagnosis codes are 7 characters long and mix letters and numbers. There are around 68,000 of them. The PCS codes that practices and insurance companies use for billing are also alphanumeric and there are 87,000 of them. This compares to only about 4,000 three or four digit codes in the ICD-9 system.
The additional length of the codes and the number of codes enables a much bigger issue that practitioners, administrators and coders will face with ICD-10 coding for podiatry. The new code system is much more detailed. What was covered by one code in ICD-9 can be broken down into as many as 50 different codes in ICD-10. This means that doctors will need to track everything that they do and see in much more detail. For instance, while ICD-9 coded an “at-home injury,” ICD-10 will require the doctor to record that someone was hurt in by walking into a lamppost in the living room.
Furthermore, ICD-9 and ICD-10 codes don’t always line up neatly with each other. A study conducted by the American Medical Association of the General Equivalence Mappings between the two codes indicated that “crosswalking” between the two systems won’t be easy. Only 24.2 percent of ICD-9 codes have an exact match in the ICD-10 system, even though the code designation will be different. Another 49.1 percent of codes have a match, but it isn’t an exact match. Another 18.7 percent allow ICD-10 coding for podiatry practitioners to choose between multiple codes in ICD-10 for the same ICD-9 code. 8 percent of codes either don’t have a match or match multiple codes depending on the scenario.
As if these challenges are not enough for a practice to cope with, the two systems will also need to coexist for awhile. Every bill that a practice submits on September 30, 2014 needs to be in ICD-9 format. Every bill starting on October 1 has to be in the ICD-10 coding for podiatry format. This means that every practice’s systems will have to store and reflect both systems, at least for a period of time. ICD-9 will also need to stay active to deal with insurance claims that take time to resolve.
With tens of thousands of new codes that percolate throughout a practice, ICD-10 coding for podiatry represent a sea change in many aspects of a medical practice. When coupled with the mandate to transition to electronic health records, many practices find themselves overwhelmed. An outside consultant that has expertise in managing the rapidly changing health care industry can help any practice turn these seemingly inconvenient changes into ways to deliver better care at lower cost and with higher productivity.