ICD 10: What you need to Know

Medical Billing is undergoing some major changes with the implementation of ICD10


According to the Center for Medicare and Medicaid Services (CMS.gov), the deadline for transition from the current International Statistical Classification of Disease or ICD9 diagnosis and inpatient procedure codes to ICD10 is October 1, 2015. With just a little over 100 days left until the deadline, there are many things medical practices need to know and prepare for to mitigate the potential revenue gap due to increases in denied claims.

For those of you unfamiliar, ICD9 codes are used by just about everyone in the medical field to classify the types of diseases and health problems recorded during patient visits. These codes are used to track and monitor the types of diseases identified and provides statistical data used to track mortality and morbidity rates. While the existing set of codes under ICD9 has received multiple updates since the final proposals were approved in 1978, the codes are outdated and lack the detailed and comprehensive classification compared to the new ICD10.

The code sets under ICD10 were approved in 1990 and adoption of the coding system by other countries around the world began around 1994. The United States is one of the last to make the transition to ICD10 and shifting the entire medical industry in our country will be a massive undertaking. Anyone covered under the Health Insurance Portability and Accountability Act (HIPAA) will be required to make the transition.

As medical providers prepare for this transition, there are a few key points to consider. First, review existing processes and procedures pertaining to the revenue lifecycle for patients (enrollment to cash application). Ensuring you have the best processes in place for gathering documentation, billing, systems, etc., will reduce the risk of non-payment under ICD10. Partnering with an experienced Revenue Cycle Management provider can help litmus test the existing processes and provide additional layers of billing and collection support.

Second, speak with your technology vendors and make sure they have updated their software to comply with the new rules and regulations. Also, speak with any other vendors such as billing companies or clearing houses to ensure they are preparing for the upcoming change.

Finally, make sure you speak with your contracted insurance companies, as the new specified coding may alter some of your existing agreements and could lead to increased denials.

While the Federal Government has delayed the implementation of ICD10 several times over the last 20 years, signs indicate that the October 1, 2015 deadline is likely to remain. CMS.gov has several tools available to start preparing for the transition and information resources to start educating your teams on how the new structure will change the way coding is performed. Change is an integral part of business, and this change is unavoidable. Give yourself enough time and start the process today.


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