United States

RSM’s Senior Living Health Care Connection: ICD 10 is coming


The Centers for Medicare & Medicaid Services has reported that a successful Medicare Fee-for-Service ICD 10 testing week has been conducted. Facilities are once again reminded to prepare for this change to take place on October 1, 2015. The ICD 9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD 10 code sets. There are basically two parts:

  1. ICD 10-clinical modification diagnosis coding is to be used by all health care settings
  2. ICD 10-inpatient procedure coding system is to be used in hospital settings

ICD 10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act, not just those who submit Medicare or Medicaid claims. Claims for services provided on or after October 1, 2015, should use ICD 10 diagnosis codes. Claims for services provided prior to October 1, 2015, should continue using the ICD 9 diagnosis codes.

Steps to take now to ensure readiness for the transition to ICD 10 include:

  • Train your staff, which includes not only the nursing staff, but the entire interdisciplinary team. Structure the training sessions to meet the needs of each discipline:
    • Admission team
    • Minimum data set (MDS) team
    • Social service
    • Nurse managers and direct care givers
    • Billing team
    • Facility managers and administrators
  • Test your software to make sure the ICD 10 codes are ready and accurate.
  • Contact your software vendor to determine how the transition will be handled in the software.
  • Revisit the diagnosis coding process
    • Who enters the admission diagnoses?
    • Who checks the accuracy of the codes to be used on the MDS, in the claims and in the documentation?
    • Who provides continual monitoring of the coding throughout the stay?
    • What is the discharge process to ensure all diagnoses are captured on the discharge note and on the readmission note?

RSM can help you achieve a successful transition to ICD 10. For more information, contact Joan McCarthy at 312.634.3479.

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