ICD-10 Transition – Facts You Should Know

ICD-10 refers to the International Statistical Classification of Diseases and Related Health Problems, 10th Edition, which describes diseases, and morbidity and mortality data. The new ICD-10 codes are to be used on all outpatient claims with dates of services as well as all inpatient claims with dates of discharge on and after October 1, 2013. This means that medical claims submitted after October 1, 2013, without the appropriate ICD-10 codes will be rejected. In fact, these codes are to figure on all HIPAA transactions. Failure to comply with this requirement may be severely penalized – your claims and other transactions are likely to be rejected; and you may be asked to submit them again with the ICD-10 codes. Though the deadline seems a long time away, it is vital that all healthcare practices and billing service providers prepare for this major transition to ensure maximum reimbursement and minimum claim denials. This change in the ICD coding does not however, affect the CPT coding for outpatient procedures. What is ICD-10? ICD-10-CM/PCS, or International Classification of Diseases, 10th edition, Clinical Modification/Procedure Coding System, comprises: • ICD-10-CM for diagnosis codingrn• ICD-10-PCS for inpatient procedure coding ICD-10-CM is to be used in all healthcare settings in the US. The major difference between this code set and the ICD-9-CM is that it uses 3 to 7 digits instead of the 3 to 5 digits in the latter. The advantage of using the new coding system is that it is much more specific and comprehensive. Why ICD-10? The ICD-9 code set in use now has become rather obsolete, since it cannot efficiently report all hospital inpatient procedures and the medical conditions of patients. When it comes to reporting diagnoses with all required details, again the ICD-9 cannot exactly meet the various requirements of the present day US healthcare system. Moreover, many other countries worldwide have already made the transition. Therefore to ensure compatibility in diagnosis coding, the US also needs to make the transition as quickly as possible. Another thing to bear in mind is the impending change in the standards for electronic health transactions including functions such as claims, remittance advices, eligibility enquiries, and more. The current Version 4010/4010A1 is being changed to Version 5010. The new version can accommodate the ICD-10 codes. Healthcare providers are expected to change over to this Version 5010 before the transition to ICD-10 is done. Otherwise, they may face delays in reimbursement. At the same time insurance payers also have to update to Version 5010 to be able to accept such transactions from healthcare providers. Rely on an Experienced Outsourcing Company The mandatory transition to ICD-10 and Version 5010 undoubtedly calls for a lot of urgent modifications within your practice. You need to train staff on these new aspects, install updated software, make the necessary changes to your business processes, spend time on testing the new software, and so on. To avoid all hassles related to these vital transitions, it is best to rely on a dependable outsourcing firm. Companies providing billing and coding services have already taken measures to meet the new requirements efficiently. You can easily entrust your billing and coding processes to a chosen service provider and benefit from huge cost and time savings.