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.