The shift from ICD-9 to ICD-10 brought some big challenges to healthcare. To help relieve some of these transition difficulties, the CDC and CMS instituted a freeze on updates to the codes prior to the October 1, 2015 implementation date, according to the American Hospital Association. But now, CMS has lifted the freeze and announced they will be adding a host of new diagnostic and hospital inpatient procedure codes (5,000+ new codes) to ICD-10 for fiscal year 2017.
A look back on last October's ICD-10 transition was recently presented during a Healthcare Financial Management Association meeting. One key finding was that medical necessity denials increased across the board following the changeover, and some hospitals reported doubling of these denials.
Errors in Medicare national coverage determinations may have played a significant role in those denials, and if so the problem should largely resolve itself as they are fixed. But the ICD-10 handover isn't finished. The ICD-10 grace period is still in effect and practices are now preparing for thousands of new ICD-10 codes.
New ICD-10 Codes to be Added
In March of this year, the ICD-10 Coordination and Maintenance Committee met to review proposals for both ICD-10-CM and ICD-10-PCS that (if approved) would be included for fiscal year 2017.
The update includes approximately 3,650 new ICD-10-PCS codes, along with approximately 1,900 new ICD-10-CM codes. The proposals also included nearly 500 revised ICD-10-PCS codes and 351 revised ICD-10-CM codes. This medical coding update includes the backlog from proposals of code changes proposed during the partial code freeze and marks the start of annual revisions to the ICD-10 code set, bringing the industry back to the regular update cycle.
Like the ICD-10 codes already in effect, new codes offer greater specificity and are designed to keep up with rapidly evolving health information demands. While ICD-10 was not the apocalyptic event that some expected, the more complex ICD-10 code set did have its impact on healthcare revenue cycle management. With the thousands of new ICD-10 codes being released, anticipate and prepare for some disruption with coder productivity and denials.
About the New ICD-10 Codes
Most of the new ICD-10 codes are focused on surgical procedures, devices, the addition of bifurcation as a qualifier, additional body parts, and codes related to congenital cardiac procedures and placement of intravascular neurostimulators.
In addition to the new codes, 487 code titles will be revised.
Changes to ICD-10-CM cover a greater list of body systems and sections of the code book, allowing more specificity for certain diagnoses to elevate patient care. For instance, there are proposed codes for blindness as well as low vision that allow more specificity to track sight loss in each eye.
The new procedure codes are available on CMS’ website, and the new diagnosis codes will be released as part of the hospital inpatient prospective payment system proposed rule for fiscal year 2017, scheduled to be released in April.
Key Performance Indicators to Track for ICD-10 Success
Comparing metrics to past calendar years by month is recommended due to seasonality of healthcare statistics, as well as individual practice issues (like staff vacations).
Baseline KPIs from before last year's transition should be compared with new KPI measurements. Many practices choose to track KPIs separately for each payer so that when issues are discovered they're easier to trace.
Some of the KPIs suggested by CMS include:
- Days to final bill
- Days to payment
- Claim acceptance/rejection rate
- Claim denial rate
- Reimbursement rate
- Incomplete or missing charges
- Incomplete or missing diagnosis codes
- Medical necessity pass rate
An ICD-10 Plan for Moving Forward
Keeping your revenue cycle management operations on track with the addition of the new ICD-10 codes will require some extra effort, but not on the level of last year's ICD-10 changeover. CMS suggests tracking your progress with several key steps:
- Creating a feedback system for staff to share their insights
- Rechecking clinical documentation and code selection and ensuring medical coding personnel have sufficient resources
- Verifying that all systems are up to date and all software fixes and patches have been applied
- Monitoring cash flow and revenue before and after the new codes are added
Prepare Now to Avoid Revenue Loss in October
As with last year's transition from ICD-9 to ICD-10, this year's addition of several thousand new codes will be easier if you prepare early. Your revenue cycle management shouldn't be as severely affected as it was last autumn, but ensuring your practice is prepared will help reduce the impact on your coder's productivity and overall cash flow.