According to the final rule implementing ICD-10-CM/PCS, these new code sets will be implemented to replace the current uses for ICD-9-CM diagnosis and procedure codes. The use of CPT® codes is not affected. ICD-10-PCS will be used to report procedures that are currently reported with ICD-9-CM Volume III procedure codes, which means that ICD-10-PCS codes will not be required on outpatient encounters.
Outpatient coders who currently assign ICD-9-CM diagnosis codes and CPT® procedure codes will need to learn to report ICD-10-CM diagnosis codes and will continue to report CPT® procedure codes. AHIMA estimates that approximately 16 hours of coding training are likely needed for each outpatient coder to learn ICD-10-CM. However, coders may need additional training to refresh or expand knowledge in the biomedical sciences.
For a successful transition to ICD-10, the challenge for outpatient coders is to:
- Ensure they have sufficient foundational knowledge of the biomedical sciences
- Learn how to apply ICD-10-CM codes correctly on outpatient encounters
- Understand how to apply maps and crosswalks between ICD-9-CM and ICD-10-CM
Earlier steps for outpatient coders in this model focus on obtaining the foundational knowledge of the biomedical sciences and understanding how ICD-10-CM is different from ICD-9-CM (including familiarity with the maps between them). Beginning two years prior to implementation, the focus is more in depth understanding of the fundamentals of ICD-10-CM and preparing to code with this new code set. One year prior to implementation, the focus is on becoming an expert in applying ICD-10-CM codes to outpatient encounters.
To Do Phase 1:
- Understand the ICD-10 final rule and its implications to your coding position.
- Learn about the structure, organization, and unique features of ICD-10-CM.
- Use assessment tools to identify areas of strength/weakness in the biomedical sciences (e.g. anatomy and pathophysiology).
- Review and refresh knowledge of biomedical concepts as needed based on the assessment results.
- Begin learning about the general equivalence mappings (GEMs) between ICD-9-CM and ICD-10-CM.
To Do Phase 2:
- Reviewcode structure and coding conventions for ICD-10-CM.
- Learn the fundamentals of the ICD-10-CM system.
- Analyze and practice applying the ICD-10-CM coding guidelines.
- Continue to review and refresh knowledge of anatomy and physiology concepts.
- Review the ICD-10-CM official coding guidelines (corresponds to task #1, 3)
- Take AHIMA's online course, ICD-10-CM Overview: Deciphering the Code (1, 2)
- Buy AHIMA publication: ICD-10-CM and ICD-10-PCS Preview, andICD-10-CM and ICD-10-PCS Preview Exercise, second edition (3)
- Purchase AHIMA audio seminars "ICD-10-CM Coding Guidelines: An Overview" (August 12, 2010) and ICD-10 Prep: Assessing Coders' A&P Proficiency, June 2011(3,4)
- Take AHIMA's online courses, ICD-10-CM Overview: Deciphering the Code (2, 3, 5)
- Take AHIMA's online Clinical Documentation Improvement in Preparation for ICD-10-CM/PCS and AHIMA ICD-10 CM Coder Readiness Assessment(3,4)
- Take an Anatomy and Physiology (A&P) refresher course such as AHIMA's Clinical Concepts for Coders or for more in-depth training, AHIMA's A&P: Core Lessons for Health Professions course or an A&P course at a local college or university (4)
To Do Phase 3:
- Become an expert in applying ICD-10-CM codes to outpatient cases in the six to nine months preceeding the implementation date.
- Practice using ICD-10-CM codes each week leading into “go live” on the implementation date.
- Network with peers to seek answers to cases and confirm application of ICD-10-CM codes.
- Take advantage of component state association (CSA) training opportunities.