Decoding ICD-10-CM for Hospices

The changeover to the new coding concepts of ICD-10 on October 1, 2015 will be a major overhaul for the hospice community, especially due to such a large portion of reimbursement being diagnosis driven. ICD-10-CM for hospice providers is the replacement coding system for the obsolete ICD-9 procedure coding in use for over 30 years now. ICD-9 is outdated, has no room for new codes in many areas, and is not consistent with the modern medical practice.

Here are some simple tips to help understand the new system:

  • The first three digits identify the category
  • The first digit is alphabetic-always
  • The second and third digits are numeric
  • The fourth to sixth positions takes care of clinical details-etiology, severity, and anatomic sites
  • The seventh character is sometimes needed to describe the characteristics of the encounter
  • ICD-10 allows the use of combination codes, which are useful in coding more than one diagnosis or a complication
  • A combination code reduces the number of codes for particular patients while providing clear and concise codes to describe a patient.
  • Using alpha coding is allowed in ICD-10. The alpha codes allow consistency throughout coding as qualifiers for body parts, approach, system and more!

Hospice and Home Health Care Codes

After October 1, 2015 all codes submitted to CMS have to use ICD-10 coding or they will be rejected. Coding and billing professionals must understand these concepts and how to apply them to claims to avoid denials.

Here is what they should do:

  • Identify which of their current and existing processes will need to migrate to ICD-10-CM, for instance electronic health records, clinical documentation, reporting protocols, billing, contracts and vendors.
  • Find out whether their contracts with providers need an update, this covers payment schedules and reimbursement. Every area of revenue for home health and hospice care is affected by the switch to ICD-10.
  • Prepare and plan for disruptions in the billing process due to ICD-10.
  • Call up their IT vendor to determine when and if an ICD-10 upgrade is scheduled.
  • Learn about the common ICD-10 codes their agency is likely to use. Test them for billing accuracy and reporting. A competent electronic health record (EHR) is critical to the process.