ICD-9-CM to ICD-10-CM transition
The transition from ICD-9-CM to ICD-10-CM is a project of considerable scale for every dermatology practice. The Academy provides many of the resources you and your practice staff need to prepare for live implementation on Oct. 1, 2014. The Academy’s four-phase approach to implementation is detailed here to help keep your transition plan on track.

Why ICD-10-CM?
ICD-9-CM is obsolete and no longer reflects current clinical knowledge, contemporary medical terminology, and modern practice of medicine. It also lacks the flexibility to accommodate advances in medicine and medical technology. The most significant difference between the two coding systems is that there is a five-fold increase in the number of diagnostic codes in ICD-10-CM. More than 68,000 ICD-10-CM codes for dermatology exist compared with about 14,000 ICD-9-CM codes. The additional diagnostic codes account for the enhanced level of detail in ICD-10-CM.

Required transition
According to a rule published by the Department of Health and Human Services, medical practices must begin using ICD-10-CM in all HIPAA transactions by Oct. 1, 2014. The transition to ICD-10-CM does not affect physician use of the Current Procedural Terminology© (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. Physician services will continue to be reported with CPT and HCPCS codes.

Many new details
There are many differences between ICD-9-CM and ICD-10-CM. Changes are mostly in code organization, code composition, and level of coding detail to reflect higher levels of specificity to address needs associated with research, quality measurement, and reimbursement. Further changes include revisions to chapter titles and categories, re-grouping of diseases, and modification of coding rules. ICD-10-CM allows for a greater level of coding detail and specificity; codes contain seven alphanumeric characters instead of the limited five-digit ICD-9-CM code set. For example, the title of chapter 1 in the ICD-10-CM is "Certain infectious and parasitic diseases," (A00-B99), which was changed from "Infectious and parasitic diseases" (codes 001-139) in the ICD-9-CM. The word "certain" stresses the fact that localized infections are classified in the pertinent body system (e.g., infection of the skin and subcutaneous tissue is in chapter 12).

Phase 1: Preparation
There are four recommended phases in ICD-10-CM implementation. Phase 1 includes developing a budget for staff training and potential system upgrades, having staff attend seminars to familiarize them with the ICD-10-CM structure, assessing staff skill levels, and assessing documentation improvement needs.

Phase 2: Engage your business associates
Phase 2 includes determining vendor readiness, which includes system vendors, payers, and providers. Discuss the ICD-10-CM transition during contract negotiations with your vendors when these come up for renewal. Request status updates on vendor progress toward ICD-10 preparedness and readiness, and inquire about whether system and/or code updates are covered under the renewed/revised contract. Communicate the importance of ICD-10-CM preparedness with your business associates, e.g., billing company, clearing house, etc., and ask them when they expect to be ready for transaction processing.

Phase 3: Training and implementation
Phase 3 includes hands-on ICD-10-CM training for staff and providers. Training should begin no later than March 2014. This is the time to implement skill development and/or enhancement programs for staff. These may include education in anatomy, physiology, and medical terminology. Assess the quality of your medical record documentation and implement documentation-improvement strategies to allow for accurate ICD-10-CM reporting. Follow up with your vendors to ensure system upgrades are complete and begin testing. At the end of phase 3, you should complete your implementation plans and prepare for live implementation on Oct. 1, 2014.

Phase 4: Assessment and evaluation
Phase 4 involves assessment and evaluation. Monitor the effect on reimbursement after your go-live date. Check for any claims denials or rejections, and check on your systems’ functionality. Keep in close contact with your vendors to resolve any errors that arise. Take a close look at coding accuracy and train or retrain staff as needed.