When the Department of Health and Human Services (HHS) pushed the ICD-10-CM/PCS implementation date back a year to October 2014, preparations for the code set switch dropped off the radar for some organizations.
While physician groups such as the American Medical Association continue to lobby congress for ICD-10 delays, hospitals and HIM departments have jumped on the bandwagon in preparation for ICD-10.
It is expected that many physicians will be queried due to the greater specificity that ICD-10 requires. It is anticipated that 50% of current documentation will not have enough specificity or laterality to code for ICD-10. For example, in ICD-9 if a patient were seen for a malignant neoplasm of the breast, we use 174.9 – (Malignant neoplasm of breast (female) unspecified site). In ICD-10, we would use C50.919 – (Malignant neoplasm of unspecified site of unspecified female breast). This cross-code is unspecific and will be rejected. In this instance, the physician should have documented to a higher level of specificity. For example, the upper outer quadrant of the right female breast – C50.4 (Malignant neoplasm of the upper-outer quadrant of the breast). In this case there would be enough specificity for the claim to be processed and paid. Happy documenting!