Navigating the latest ICD-10 code changes may feel tedious, but it remains crucial for medical practices. Here's a guide to help you prepare.
We know it seems like you just got comfortable with the last round of ICD-10 code changes, and now another set of revisions is right around the corner. As tiresome as it sounds, keeping up with ICD-10 updates is all a part of running a modern medical practice. The new codes help capture innovative treatments and rising diagnoses, while revised guidelines reflect advances in medicine.
So even if reviewing all those new codes makes your eyes glaze over, you must stay up to date. Using outdated ICD-10 codes can result in rejected claims and billing headaches that cause disruptions to your revenue cycle and operations. There is good news though. By being prepared, your practice can successfully navigate through the ICD-10 code changes as smoothly as possible. Today, we hope to break down what's changing, how to prepare, and what resources to turn to.
The Importance of ICD-10 Codes
What are ICD-10 codes? ICD-10 codes classify medical diagnoses, symptoms, procedures, and more for clinical, billing, and research purposes. ICD-10 codes are used in medical records and on insurance claims to share crucial information with billers, payers, researchers, and public health officials. These codes also drive proper reimbursement by capturing details on patient encounters, medical necessity, and provider work.
Payers process claims more efficiently when they are supported by specific, comprehensive ICD-10 codes. Accurate codes help demonstrate adherence to quality care guidelines. In all medical practices, ICD-10 codes have a direct impact on clinical documentation, care coordination, and patient outcomes. Specific ICD-10 details allow providers to fully document a patient's history, and the codes help to promote an accurate exchange of information across care teams. This coding precision ultimately supports the delivery of optimal, individualized care.
Announcing the 2024 ICD-10 Code Changes
The ICD-10 code changes for 2024 were announced by CMS through the proposed IPPS rule for FY 2024, and this was issued in January 2023. This rule lays out payment policies and rates for inpatient services provided by hospitals in the coming year. The IPPS rule for FY 2024 includes an overall net increase of 2.8% in payments for acute care hospitals that meet quality reporting and EHR meaningful use requirements. This translates to an expected $3.3 billion increase in hospital payments in FY 2024 compared to FY 2023.
However, CMS also proposed a $115 million decrease in payments for disproportionate share hospitals. Revenue cycle leaders should closely review the full IPPS proposed rule to thoroughly analyze the potential impacts on reimbursement and workflows from the ICD-10 code changes and payment rate adjustments taking effect October 1.
Key Highlights of the 2024 ICD-10 Code Changes
The proposed ICD-10-CM diagnosis code changes for fiscal year 2024 are significant and wide-ranging. In total, there are 395 new codes added, 12 existing codes revised, as well as 13 revisions across the code set.
- Several medical specialties will be impacted by the new and revised codes, including:
- Neurology — 5 new codes added for Parkinson's disease, specifying with or without dyskinesia
- Hematology — Multiple new codes introduced for sickle cell anemia to capture greater specificity
- Ophthalmology — 4 new codes established for migraine with aura
- Endocrinology — 3 new codes for insulin resistance
- Other notable code set updates:
- 123 new external cause codes related to accidents and injuries
- 36 new codes for osteoporosis with current pathological pelvic fracture
- 2 new codes to capture reasons behind caregiver non-compliance (financial hardship or other)
- To better compensate for resource utilization needed for patients experiencing homelessness, the severity level designation would increase for 3 existing homelessness diagnosis codes
The proposed changes have been put in place to better capture new clinical concepts, technologies, and diseases as well as improve reimbursement in certain areas.
Preparing for Implementation
October 1st is fast approaching, and the time to prepare is right now. While it may feel like another challenge added to a longer list of major challenges, getting organized with a solid plan will ensure your healthcare facility is ready when the date arrives. Get key stakeholders involved early and tap into the skills and experience across your practice—you likely have more resources than you realize! Little by little, the pieces will come together for a successful implementation.
Key steps include:
- Conducting comprehensive ICD-10 training for all clinical documentation, coding, and billing staff. Coders should refresh their knowledge of documentation guidelines and coding best practices as well.
- Assessing EHRs, revenue cycle management platforms, as well as other systems for readiness to integrate the 2024 ICD-10 code changes. Vendors and IT teams need to update interfaces, templates, groupers, encoders, and other tools to enable the capture and processing of the new codes.
- Communicating upcoming changes that will impact clinical documentation, reimbursement, and internal workflows to both internal teams and external partners. Produce detailed implementation plans and timelines and provide training where needed.
Building ample preparation time enables organizations to thoroughly prepare and collaborate for a successful ICD-10 transition. A proactive approach minimizes disruptions when the new codes take effect.
The Role of Clinical Documentation
Clinical documentation directly impacts coding accuracy. Providers should have information on ICD-10 revisions related to their specialty and have relevant training on documenting specific details required for new or revised codes. Examples include laterality, episode of care, healing status, as well as social determinants of health factors. Thorough, precise documentation is key to assigning the most accurate ICD-10 codes. Clinical documentation that is vague, incomplete, or delayed leads to coding delays and inaccuracies. Lack of specificity can cause mismatched codes as well as compliance risks.
Clinical documentation improvement programs can help address issues. Here are some tips for optimizing documentation:
- Fully document history, exam findings, diagnoses, and treatment details
- Specify laterality, episode timing, severity, and other qualifiers
- Adhere to official coding guidelines and requirements
- Avoid jargon, abbreviations, and unclear shorthand
- Use EHR features like templates to capture all data
By keeping coding implications in mind during clinical workflows, providers can document patient encounters for optimal code assignment. This also supports accurate billing, quality reporting, and information exchange.
Testing and Compliance
Thorough testing of the new 2024 ICD-10 code changes prior to implementation is crucial to confirm systems and staff are truly ready. Coders should code a wide range of sample cases using both current and new codes to identify any trouble spots or discrepancies before they could affect live claims. Providers must remain fully compliant with all ICD-10 coding conventions and documentation guidelines to support accurate billing once the new codes go live.
Any non-adherence to official guidelines risks claim denials, intensified audit scrutiny, and even allegations of fraud. Complete staff training is key to stressing proper coding practices expected under the new ICD-10 code changes. Also, medical practices should conduct internal audits after implementation to identify any documentation gaps, coding errors, or opportunities for improvement. Timely issues can then be addressed through added staff education, modifications to coding protocols, and potential EHR enhancements.
Taking a proactive approach ensures a smooth transition to the new codes.
Resources for Assistance
Fortunately, help is available to guide practices through the transition:
- ICD-10 manuals, code lookups, and training tools from CMS, CDC, AAPC, and more
- Coding seminars and certificate programs offered by AHIMA, AAPC, and professional societies
- Consulting services assisting with system assessments, staff education, and workflow optimization
- Online courses that cover 2024 ICD-10 code changes and documentation tips
- Encoder software and EHR vendors providing updated code sets
- Specialty-specific guidance tailored to the impacts on clinical practice
Combining internal training with external resources helps staff quickly master the new codes and guidelines. Vetted educational materials from reputable organizations bring coders fully up to speed.
Potential Impact on Revenue and Reimbursement
Improved coding specificity under ICD-10 generally supports accurate reimbursement. However, new codes also bring the risk of temporary claim denials as payers adjust systems. Prepare for potential short-term revenue effects. Be proactive by:
- Auditing claims to verify documentation supports the level of coding
- Appealing any erroneous claim denials due to outdated payer systems
- Considering temporary use of prior diagnosis codes if issues emerge
- Ensuring coders have sufficient education on proper diagnosis sequencing protocols
With some temporary hiccups possible, the enhanced ICD-10 details should still support accurate reimbursement long-term.
Your Path to Seamless 2024 ICD-10 Compliance
Staying current with the latest ICD-10 code changes may feel tedious, but it remains crucial for proper reimbursement, streamlined billing, and leveraging health data. Treat the upcoming 2024 updates as an opportunity to fine-tune documentation, billing, and coding workflows. With planning and preparation, your practice can implement the changes smoothly.
And if the task still seems like too big of a hurdle to climb, outsourced revenue cycle management services can take the hassle out of ICD-10 transitions. Partnering with BillFlash RCM services can minimize disruptions—allowing you to focus on advancing patient care.