The ICD-10 changeover is a year away, and pundits are ramping up their rhetoric. True, there’s a lot of work to be done, but looking at the facts is always helpful. Here are 10 things that will be true starting October 1, 2014:
- Claims will be denied if they include an ICD-9 code.Because it already granted an extension, CMS has said there will be no grace period during the changeover. Any bills submitted after October 1, 2014 with ICD-9 codes will be rejected. The only exception is certain workers’ compensation claims, which are not mandatedunder HIPAA.
- All IT systems will need to accept the new code sets.Your clinical and billing systems must be ready to handle the longer codes. If you plan to dual code, you may need additional storage space to accommodate.
- Physicians will document differently. Assigning the proper ICD-10 code involves specific anatomical, healing stage, and episode information, necessitating a change in the way physicians document each encounter.
- Certain front-office procedures will change. This will vary by practice, but some forms will likely need updating, including HIPAA notifications. More information will be captured and shared under ICD-10.
- Superbills will be obsolete. The complexity of ICD-10 coding will eliminate a “top 20” code list for most practices.
- Diagnosis codes will incorporate CPT information. In many cases, ICD-10 codes include information that, in the past, was only included in the procedure code.
- Unspecified codes may lead to a record request and/or denial. Although there will still be unspecified codes available for use with ICD-10, if you use them when more accurate codes are available, the payer may reject the claim. When a payer performs an audit on the medical record and finds that the service could have been reported to a higher level of specificity, it can request the payment be returned.
- Labs may experience code-related disruptions. Incorrect or missing codes are problematic for labs and other diagnostic departments, and these are likely to increase during the ICD-10 transition. As always, the more education the better, and labs must continue to be careful about how they request missing information so as not to inadvertently lead physicians.
- Vendor contracts need to be examined and updated. Specifically, practices will need to look at any changes to government mandates and update some contracts to reflect new privacy and payment policies.
- Analytics will become even more important. As practices strive for revenue neutrality during the code changeover, they will be closely tracking all things financial.
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