8 Months Until ICD-10 Implementation: What to Know

Most medical providers are aware that October 1, 2015, is the date they must quit using the outdated ICD-9 billing codes and begin using ICD-10 codes.  The implementation date has been postponed more than once and it is not expected to be postponed again (however, rumors are beginning to swirl around Congress).

Most medical providers are aware that October 1, 2015, is the date they must quit using the outdated ICD-9 billing codes and begin using ICD-10 codes.  The implementation date has been postponed more than once and it is not expected to be postponed again (however, rumors are beginning to swirl around Congress).  In order for your medical practice to maintain collections and avoid having claims denied, you already know that it is imperative for you and your staff to be ready and begin using the new codes on October 1, 2015.  

If you are not yet prepared, there are many sources available to you to guide you so that you will be ready for implementation.  You can find transition resources through the Center for Medicaid and Medicare Services (CMS), your particular medical or surgical board or a revenue cycle management company like Health Information Services, LLC (HIS).

What you need to know

There are a lot of rumors about how ICD-10 will and will not work and what the requirements are. CMS has provided a fact sheet to distinguish ICD-10 facts from fiction.  Here are some highlights and some added opinions.

• Despite widespread rumors to the contrary, the Department of Health and Human Services (HHS) has absolutely no plans to issue any more compliance date extensions.  You must be prepared for ICD-10 implementation on October 1, 2015.  However, an act of congress similar to that of last year can delay the transition yet again no matter what assertions CMS and HHS make. 
• You may not submit claims with both codes from both code sets included.  For services performed prior to October 1, 2015, claims will be returned if they include ICD-10 Codes.  For services performed on October 1, 2015 and thereafter, claims must only contain ICD-10 Codes or they will be rejected and denied.
• Even though non-covered entities like Workers’ Compensation are not required to use ICD-10 Codes, CMS is encouraging them to make the transition since ICD-9 Codes will not be maintained after October 1, 2015. You will not need to have two billing systems in your office and it is expected that non-covered entities will make the transition to the new codes.  However, you will need to be prepared to bill both code sets depending on payor specific policies.
• The concerns about the increased number of codes making ICD-10 impossible to use are somewhat unfounded.  According to CMS, adding more codes is no different than adding words to a dictionary. There are electronic coding tools and an Alphabetic Index that will help you in choosing the proper code. The increased number of codes does make the old days of a paper encounter form or superbill near impossible.  We also suggest that physicians do not attempt to learn the entire code set but to understand what needs to be present in their dictation.  Reliance on Certified Professional Coders with certification in ICD10 is paramount to success in this environment.
• ICD-10 will actually be more clinically sound than ICD-9 because it allows you to be more specific as to the services you performed and gives you the ability to be more clinically accurate in your diagnosis and the treatment you provided. A good example of this is the requirement to document and code for laterality.
• Despite the large number of additional codes, you will only need to use a small number that are specifically related to your own specialty practice.  This may be true for some specialties, however, for Orthopedics ICD10 is a massive undertaking.  60% of the ICD10 set is specific to Musculoskeletal and therefore will affect Orthopedics directly.
• Some rumor-mongers erroneously complain that the new codes were developed without input from medical providers.  In fact, medical specialty societies made substantial contributions to the development of ICD-10 Codes.  Similar to meaningful use, there was input from multiple sources whether it be providers, professional associations, special interest lobbyists (good and bad), insurance companies, et al but when the suggestions turn to substance the ramifications in the clinical setting become a stark reality.
• When a definitive diagnosis cannot be made, ICD-10 provides more signs and symptoms codes and has nonspecific codes that can be used when certain clinical information is not available or is unknown.  We suggest being very careful using any unspecified codes as we feel these codes will be denied by most payors. 

The change is coming.  No more postponements.  (Unless, another act of Congress similar to 2014).  You can prepare by taking courses offered by various entities.  On the other hand, you can take advantage of Health Information Services (HIS) revenue cycle management, billing, and coding services to relieve yourself of a large portion of the headache that comes with ICD-10 transition and preparation.

Courtesy Photo: StuartMiles/freedigitalphotos.net