Medical Coding Services and Physicians - What Impact Will the Switch to ICD-10 Have on You?

You have probably heard by now that the required switch to using ICD-10 has been delayed by a few years. You can breathe a little easier for now, but have you begun to consider how your office will implement the changes? And what do these changes mean to you anyway?

A little background...as you know, insurance companies do not pay for "tension headaches" and "15 minute office visits for an established patient" - insurance companies pay for medical diagnosis codes like 307.81 and procedure CPT codes such as 99213. Diagnosis codes, CPT and HCPCS codes all describe patient complaints, illness, procedures and supplies for a submitted claim. The ICD-9 codes currently in use were adopted in the 1960s by the U.S. Since then there have been many advances in healthcare. Under the current coding system, the room to expand is limited. By adding codes under the new system, there will be room to expand and be more specific in reporting.

How much so? Think there are a lot of codes now? Try 68,000 diagnoses codes, up from 13,000 now. For procedure codes (CPT) we go from 3000 codes now to 87,000 codes! What is more, ICD-9 codes will go from up to 5 digits (ex. 307.81) to up to 7.

The deadline for implementation is 2013, which is still in the future. According to a recent article in the Wall Street Journal: "CMS says it expects implementation of the new system initially will boost by as much as 10% the number of claims returned because of coding errors. But a study by the Blue Cross and Blue Shield Association of insurers predicts billing errors are likely to rise between 10% and 25% in the first year."

If you currently do your billing in-house and file using on-site software, the switch to ICD-10 could be a large expense for updates to your software as well. By the start of 2012 all physicians must begin using the new version of HIPAA transaction standards known as 5010 in order to file claims. This is due to the fact that the current 4010 version does not accommodate ICD-10 codes. Even if you believe you can put off updates to switching to ICD-10, you should at the very least start considering what it will take to update to the 5010 transaction standards.

It may be a good time to consider either a switch to outsourcing your billing to pass the cost off to a billing company, or at least consider an internet based billing program. The advantages with internet based electronic claims filing is that the updates are built in to the platform at no cost to you other than your regular fee of using the service. This could potentially save you thousands upfront as well as over the long run. The whole purpose of the switch to ICD-10 is to accommodate the annual updates in technology and procedures. You can be sure that any in-house software you use for claims filing will require annual updates that can represent cost to you as well.

You can see why it will be more important then ever to have a coder educated on the new codes as a part of your practice. Implementation of the new system will be costly, so when the time comes, out-sourcing your coding could be a cost-saving solution.

Jeff Roh is owner of Profast Billing Solutions, offering physicians billing services and medical coding services. He writes articles on important and current issues relating to insurance billing for the medical community. For more information visit http://www.profastbilling.com

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