ICD-10 Coding For OB/GYN
By Daniel Schwartz, content strategist
Are you and your staff anywhere near ready for ICD-10’s October 1st deadline? Maybe you’ve been so overwhelmed just trying to implement all of the other changes happening in healthcare thanks to the Affordable Care Act, EMR mandates, increased Medicare audits, and value-based purchasing penalties, you’ve had little time to prepare for this latest coding switch.
Well, if you haven’t had time before this, you’re going to have to make time now, because this ICD-10 transition is most likely going to be stressful and expensive for your practice and how to get access to ICD-10 training for physicians will be the first question on your mind.
How Will ICD-10 Differ From ICD-9?
The most obvious difference between the two systems is the number of diagnostic codes. ICD-9 had about 14,000 codes, whereas ICD-10 will have 68,000 codes. The addition of 50,000+ codes is staggering.
The other difference is the ICD-10 PCS (procedure classification system). The new system increases the number of procedure codes nearly 20-fold when compared with the old ICD-9 set. We’re talking going from about 4,000 procedure codes to 87,000 procedure codes.
As you can imagine, ICD-10 codes allow for far greater specificity in clinical documentation. For example, the old ICD-9 system did not address laterality nor the episode of care. The old system also lacks other clinical specificities. For instance, ICD-9 had one single code for a closed fracture of the femur (821.01) whereas ICD-10 will have at least 24 codes dealing with these kinds of fractures.
Another way ICD-10 codes differ is that they are structurally more complex containing 3 to 7 alphanumeric characters instead of ICD-9’s 3 or 4 characters. The first character of an ICD-10-code must be a letter, the second character will always be a number, and the remaining 5 characters can either be letters or numbers.
You’ll notice all of the letters from the alphabet are used except for the letter “u.” A decimal point is to be placed after the first 3 characters and laterality may be noted with the 5th or 6th character (1 = right; 2 = left; and 3 = bilateral). There are certain CM code categories, including specific OBs, which will always require a 7th character that describes the type of encounter (A = initial; D = subsequent or S = sequelae), or the identity of the fetus in a multi-fetus pregnancy.
Something to be aware of using the new ICD-10 code sets: if there are fewer than 6 other characters but a 7th character is necessary, you are to use “x” as a placeholder so that all 7 values are present, for example, O69.0xx3 labor and delivery complicated by prolapse of cord, fetus # 3.
How Will These Changes Affect OB/GYNs?
You will be happy to know (that was sarcasm) there are twice as many OB/GYN codes in ICD-10 (2,155) as there were in ICD-9 (1,104). These new codes have been created to allow for more specificity to the characterization of obstetrical conditions. The ICD-10 obstetric codes can be found in Chapter 15 and have sequencing priority over those from other chapters. The codes begin with the letter “O” not the number zero.
There are also more codes to describe the nature of medical complications during pregnancy. ICD-10 allows for providers to classify diabetes complication as pre-existing (type 1 or 2) as well as by the trimester in which the complication occurred. For example, 024.011 refers to “Pre-existing diabetes mellitus, type 1, in pregnancy, first trimester.”
Another change requires a code from category Z34 (“Encounter for supervision of normal pregnancy”) for routine office visits during uncomplicated pregnancies. This code would be the first listed diagnosis and no codes from chapter 15 would have to be included.
Code 080 is to be used when a patient has had an uncomplicated full-term pregnancy and delivered a healthy singleton fetus and, again, no other codes from chapter 15 are required. This code should be accompanied by Z37.0 (single live birth) as the only outcome-of-deliver code.
Preparing For The ICD-10 Transition
To successfully implement the new ICD-10 codes, extensive preparation by physicians and staff is required and training is recommended for everyone. Coders in particular will now have to have a greater knowledge of anatomy, physiology as well as medical terminology.
Physicians will be required to offer far more elaborate documentation because a higher level of detail is necessary to support the new ICD-10 codes. For this reason, physicians should also consider getting training. Software will need to be upgraded and those practices who use compatible EMRs may want to consider investing in new computer-assisted coding (CAC) programs.
Successful implementation will also require organization and a careful assessment of current office processes to determine whether they will support the new code set roll-out. Your planning should include coordinating with payers and testing systems to be sure everyone is up-to-speed for October 1st.
Having stated the importance of planning and training, there is already evidence that the transition to ICD-10 will increase coding time delays in accounts receivable and denied claims. Add to this revenue hit the fact that software updates, training and possibly hiring new staff won’t be cheap and you understand why industry experts have been recommending that physicians save up at least 6 months of revenue as a safety net. Haven’t been able to do that? Then speak with your bank about a loan or a line of credit.
ICD-10 is not going to magically disappear. The change is coming and it should come because we are the only country with modern healthcare that is still using the outdated ICD-9 codes. In fact, some countries are preparing for the switch to ICD-11. While the update will no doubt increase practice costs and the workload of OB/GYNs and their office staff, in the long-run, ICD-10 ultimately means improved public health and patient safety, and better resource utilization. It will also most likely reduce CMS fraud and abuse.
About The Author
Daniel Schwartz is a content strategist who sheds light on various engaging and informative topics related to the health IT industry. His belief in technology, compliance, and cost reduction has opened new horizons for people in the healthcare industry. He is passionate about topics such as Affordable Care Act, EHR, revenue cycle management, and privacy and security of patient health data. He can be contacted at https://twitter.com/dschwartz20.