Decoding of ICD-10-CM for hospices

The transition to ICD-10's new coding concepts on October 1, 2015 will be a major overhaul for the hospice community, especially since such a large portion of reimbursements are diagnosis-based. ICD-10-CM for Hospice Providers is the replacement coding system for the obsolete ICD-9 procedure coding that has been used for over 30 years now. ICD-9 is outdated, has no room for new codes in many areas, and does not reflect modern medical practice.

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

• The first three digits indicate the category


• The first digit is alphabetical, always


• The second and third digits are numeric


• The fourth to sixth positions provide clinical details - etiology, severity, and anatomical locations


• The seventh character is sometimes needed to describe the features of the encounter


• ICD-10 allows the use of combination codes, which are useful when coding more than one diagnosis or a complication


• A combination code reduces the number of codes for certain patients and provides clear and concise codes to describe a patient.


• The use of alpha coding is allowed in the ICD-10. The alpha codes ensure consistency when coding as qualifiers for body parts, approach, system and more!

Codes for hospices and home care

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

Here's what they should do:

• Identify which of their current and existing processes need to be migrated to ICD-10-CM, for example electronic health records, clinical documentation, reporting protocols, billing, contracts and suppliers.


• Find out if their contracts with providers need an update, this includes payment schedules and fees. Every revenue area for home care and hospice care is impacted by the move to ICD-10.


• Prepare and plan for disruptions in the billing process due to ICD-10.


• Call their IT provider 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.


• An integrated EHR can overcome the challenges of the ICD-10 transition for hospices and home care providers.


• Software designed specifically for their needs should automate the unique process from the beginning of data collection through every aspect of the care process.


• Educate and train their staff for this monumental change. For example, providers should consider how to transfer their most common ICD-9 hospice diagnosis codes into ICD-10.


• Testing efforts need to be renewed by Hospice providers to ensure their system can support ICD-10.

The ICD-10 code set will provide a truckload of new codes and new coding procedures. Hospice providers should prepare well in advance to catch the pulse of this transition.