Outpatient Coder

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:

  1. Understand the ICD-10 final rule and its implications to your coding position.
  2. Learn about the structure, organization, and unique features of ICD-10-CM.
  3. Use assessment tools to identify areas of strength/weakness in the biomedical sciences (e.g. anatomy and pathophysiology).
  4. Review and refresh knowledge of biomedical concepts as needed based on the assessment results.
  5. Begin learning about the general equivalence mappings (GEMs) between ICD-9-CM and ICD-10-CM.

Corresponding Resources:

To Do Phase 2:

  1. Reviewcode structure and coding conventions for ICD-10-CM.
  2. Learn the fundamentals of the ICD-10-CM system.
  3. Analyze and practice applying the ICD-10-CM coding guidelines.
  4. Continue to review and refresh knowledge of anatomy and physiology concepts.

Corresponding Resources:

To Do Phase 3:

  1. Become an expert in applying ICD-10-CM codes to outpatient cases in the six to nine months preceeding the implementation date.
  2. Practice using ICD-10-CM codes each week leading into “go live” on the implementation date.
  3. Network with peers to seek answers to cases and confirm application of ICD-10-CM codes.
  4. Take advantage of component state association (CSA) training opportunities.

Corresponding Resources: