The transition from ICD-9 to ICD-10 is as divisive an issue as many in the healthcare industry today. When the news came out that the deadline for the switch was being pushed back until October 2014, some viewed it as a positive while others viewed the delay as a negative.
No matter what side of the fence you fall on, there’s no denying there are going to be many more codes to deal with when the switch finally happens. ICD-9 uses approximately 13,000 diagnosis codes and 4,000 procedure codes while ICD-10 will use 68,000 and 87,000.
This means more codes for all physicians, but some specialties face a more difficult transition than others. Three specialties confronting a particularly daunting challenge are pediatrics, cardiology, and nephrology.
These specialties are seeing drastic changes to some of their most commonly used codes. If you’re a physician specializing in one of these fields, there are some serious headaches to come if you and your staff don’t prepare for the transition.
Pediatricians
As a pediatrician, the primary challenge comes from the sheer volume of new codes you’ll be billing. Because, unlike many other specialists, you treat the entire body.
One common condition in pediatrics is bronchiolitis. In ICD-10, there are two acute bronchiolitis codes that specify the responsible organism: RSV (J21.0) and human metapneumovirus (J.21.1). In ICD-9, there is only one code for RSV (466.11), and no specific code for human metapneumovirus, which falls under Other (466.19).
Another commonly used code that will go to the wayside is 774.6, the code for unspecified neonatal jaundice. You will now use P59.9. Of course, if jaundice does have a specified reason, you will have to code it as such.
Cardiologists
If you’re a cardiologist, not only will you be dealing with code changes, but definition changes as well.
In ICD-10, the acute phase of myocardial infarction has changed from eight weeks to four weeks. Simply thinking of the old definition can lead to a miscode.
Also, the codes specifying the episode of care have been removed. For example, AMI of the anterolateral wall is coded as 410.00 for an unspecified episode of care in ICD-9. This converts to I21.09 in ICD-10, which doesn’t bother with episodes of care at all.
Other changes to watch out for are combination codes that didn’t exist before. For example, atherosclerotic heart disease of the native coronary artery with angina pectoris would’ve taken two separate codes in ICD-9, but in ICD-10 only takes a single combination code: I25.11.
Nephrologists
Relearning the codes for various types of chronic kidney disease (CKD) will be the toughest challenge to nephrologists because of the large quantity of patients who suffer from the condition. According to the National Kidney Foundation, 26 million adults have CKD.
For coding diabetic CKD, multiple codes must be used. One code indicates the type of diabetes with CKD and the other indicates the stage of CKD. In ICD-9, there was only one diabetes code, but in ICD-10 there are now five.
Coding for hypertensive chronic kidney disease is very similar in that it takes two codes. The second code still indicates the level of CKD, but the first indicates the patient has both hypertension and CKD.
Regardless of your specialty, there are some general things you can do to prepare your practice for ICD-10. Preparing as soon as possible is essential because once the deadline hits your ICD-9 codes will be useless.
Switching to ICD-10 will be a tough transition, but having a good EHR can make things easier. Check out our EHR Buying Guide.
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