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Health care practitioners should begin preparing now for the implementation of the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), according to U.S. Centers for Medicare & Medicaid Services (CMS).

“The ICD-10s are coming,” said Daniel Duvall, M.D., medical officer for the CMS’ Medicare Hospital and Ambulatory Policy Group, during an Aug. 3 conference call titled “ICD-10 Implementation Strategies for Physicians.”

The American health care system will formally implement the new health care coding system on Oct. 1, 2013, CMS officials noted during the conference call.

Effective that date, health care practitioners – including optometrists – in all health care settings will be required to indicate diagnoses on claims and other documents using the ICD-10 Clinical Modification (CM) codes instead of the currently used ICD-9 CM codes.

The CMS emphasizes that services provided through Sept. 30, 2013, must be billed with ICD-9-CM diagnosis codes while services provided on or after Oct. 1, 2013, must be billed with the ICD-10-CM diagnosis codes.

Optometrists and other health care practitioners in office settings will continue to use the American Medical Association’s Current Procedural Terminology (CPT) to describe services provided to patients. They will also continue to use the U.S. Department of Health & Human Services’ (HHS) Health Care Procedures Coding System (HCPCS) to describe health care products as well as any services not covered in the CPT codes.

Health care practitioners, institutions and claims processors are to have software systems that accommodate the ICD-10 codes in place on Jan. 1, 2012, so as to allow plenty of time for testing, according to the CMS.

“The (ICD-10-CM) deadlines are firm. There will be no delays,” Dr. Duvall emphasized.

The ICD-10-CM codes are developed by the World Health Organization, an arm of the United Nations. The United States is required to implement the coding system under an international treaty. The ICD-10-CM codes are already in use in most developed nations around the world.

The ICD-10-CM coding system is designed to facilitate better health care data collection, more accurate billing for health care services, more comprehensive and accurate patient records, health care quality measurement, and performance-based reimbursement, CMS officials say. It is an integral part of the nation’s move toward a nationwide system of electronic health records (EHR) and a reformed health care system, they add.

The ICD-10-CM will represent a considerable adjustment for the U.S. health care system, CMS officials acknowledge, although it will be less of an adjustment for health care practices than for institutions.

The ICD-10-CM code set – with some 68,000 codes – is much larger than the currently used ICD-9-CM –  which has 14,000 – and provides for more anatomically specific and detailed reporting of conditions as well as new diagnoses not covered under the older coding set.

While EHR and practice management software system will greatly assist health care practitioners and their office staffs in properly reporting diagnoses using the ICD-10-CM codes, both practitioners and staff will need to have a good working knowledge of the coding system, CMS officials emphasize.

Health care practitioners should begin making plans for the implementation of the ICD-10-CM codes in their practices now, the CMS officials advised during the conference call.

They suggest practitioners hold initial staff meetings on ICD-10-CM and provide information on the coding system as quickly as practical.

Practitioners should also now be contacting their practice software providers or billing services to make sure they will be prepared to meet the coming January deadline for the installation of ICD-10-CM-compliant systems.

To properly accommodate ICD-10-CM codes, software systems must meet specifications outlined in a set of software operating standards known as ASC X12 Version 5010.

Health care practitioners should plan to take formal education courses on the ICD-10-CM – and provide such courses for their office staff – roughly six to nine months prior to the October 2013 implementation deadline, officials suggest.

Hospitals in 2013 will be required to begin using ICD-10 Procedure Coding System (ICD-10-PCS) codes to describe health care procedures and treatments provided to inpatients as well as the ICD-10-CM codes to describe diagnoses.
 Health practitioners in office settings will eventually be required to use the ICD-10-PCS procedure codes.

The AOA Clinical and Practice Advancement Group (CPAG) is developing materials to assist optometrists with ICD-10 implementation. A more detailed article on the ICD-10-CM coding system will appear in a future issue of Optometry: Journal of the American Optometric Association.

Additional information can be found on the AOA Web site ICD-10 page (www.aoa.org/x15504.xml).