Harmony Healthcare Blog

ICD-10 in the SNF - Be Prepared

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jun 26, 2013

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Edited by Kris Mastrangelo

The implementation date of the ICD-10 transition has been delayed until October 1, 2014.  It is recommended that providers gear up for the transition by taking a look at the ICD-9 codes most commonly used in their facility and problem-solving what ICD-10 code(s) will most likely replace them.

The ICD-9 system has been in place so long that many providers have memorized the common codes used in their practice, or have hand-written “cheat sheets” of the ICD-9 codes used the most on their claims.  The transition to ICD-10 will be a challenge, because coding for common conditions will be much more specific.

ICD-10 coding requires an increased level of specificity for many diagnoses.  A single ICD-9 code may have several ICD-10 codes relevant for the same diagnosis, due to the increased level of specificity.  Harmony (HHI) suggests that the billing and clinical teams work together to determine if current documentation practice would be specific and detailed enough to select the best ICD-10 codes.  Practicing ahead of time will help clinical staff identify where their documentation needs to be more detailed to better support ICD-10 coding.

One commonly coded area is fractures.  Many providers have several ICD-9 codes they use for fractures memorized, and will use those familiar codes for claims.  ICD-10 expands the specificity of the fracture codes to include not only the site and location of the fracture, but also the laterality and type of fracture.  In another example, coding for certain injuries will include the cause of the injury, where the injury occurred, what the patient was doing when the injury occurred, and the external cause status (work-related, military, or other).  All of these details will gathered through documentation of patients’ Prior Level of Function (PLOF) on the Rehabilitation evaluations or the Nursing Admission Assessment.

It is also recommended that facilities look at their current practice for the all-important end of month triple-check meeting.  With the increased detail of ICD-10 coding, there will be an increased risk of inconsistencies in coding on the UB-04, MDS 3.0, and Rehabilitation evaluations.  There is also an increased risk of choosing an incorrect code.  Providers will need to use the triple-check meeting to ensure that all sources reflect the correct ICD-10 code for each patient.

CMS has released a suggested timeline for implementation activities related to ICD-10.  Although these timelines are geared toward physician office practices, many of the steps can be translated into a Skilled Nursing Facility.  The CMS timelines can be located at the following link:


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Tags: CMS, Denial Management

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