North Carolina Koscheski HeadshotThe much publicized and anticipated International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) transition has come and gone with very few problems, but have we heard the last of this?  If you recall, the implementation process was somewhat turbulent — the initial transition date was delayed, re-announced, and finally enacted one year later.  Understandably, there were a lot of anticipated concerns with this major overhaul of the ICD-10 coding system.  At first glance, once the dust settled, it seemed that there were very few complications that were being reported.  However, if you take a closer look, you will realize that some principal factors of ICD-10 are being transitioned by allowing a one year grace period on the usage of ICD-9, as opposed to the highly specified coding that is in fact a critical part of ICD-10.  This one year grace period granted by CMS will come to an end this October, which may result in problems on varying levels, depending on your group.  Private insurance companies will determine their own deadlines.

The one component of ICD-10 that we are all aware of is the new, highly specified level of coding for the most detailed diagnostic information possible.  The ICD system began as a product of the World Health Organization (WHO) to help track morbidity and mortality data for the purpose of population health management and development.  One of the goals of this latest version is the ability to use claims data to collect information regarding disease management to a degree that provides a much higher level of specificity.  The hope is that this will result in the collection of large volumes of claims data that can actually provide meaningful input in patient management decisions over the next few years.  To this end, the utilization of the former broad and nonspecific codes will be rejected with the new requirement for more specific information regarding the coded disease entity.  Once the grace period has expired, these generalized codes will no longer be accepted, and a more detailed code must be used in its place.

Since the computer generated reports are produced using the specific coding system that was downloaded by the provider, the general office visits and procedures done within this particular system are not the areas of greatest risk.  There are three areas of potential risk that need to be evaluated to assure a continued smooth transition:

  1. Any procedures done at an outside facility utilizing a reporting system not within your control. Is the endowriter utilized at the hospital using the updated coding information?
  2. Most of us use simple check lists to turn in our hospital E&M coding. This relies on you to provide coding that is of the proper level of specificity.  If you are not up-to-date on the correct coding information, the likelihood of mistakes is almost a certainty.
  3. Your office personnel who handle claims rejections. They must be able to quickly look at the denied claim and understand where they need to be looking to be able to correct and file a clean claim.

What should we be doing now to keep ahead of these deadlines?
Members are encouraged to use ACG’s “ICD-10 Playbook” to help with this second phase of the transition:

  • Utilize the ACG & The Coding Institute’s “ICD-9 to ICD-10 Bridge” to quickly compare any ICD-9 code to its corresponding ICD-10 code(s).
  • ACG has also compiled a list of handy charts that compares the ICD-9 codes and descriptions to the corresponding ICD-10 codes. You are free to print these out and distribute amongst your office. For your convenience, ACG divided the charts into the ten GI disease categories.

We need to be taking advantage of ACG offerings to make sure that we fully understand ICD-10 in order to minimize our errors.  Staff members involved in claims processing should also be trained or refreshed in anticipation of the October deadline.  This will better arm you and your staff with the best information possible as we continue ahead with these challenges.


Caroll Koscheski, MD, FACG
ACG Board of Trustees
Gastroenterology Associates, PA
Hickory, NC