Transition From ICD 9 Codes to ICD 10 Codes - What Concerns This Medical Billing Business Owner

The transition from ICD-9 Codes to ICD 10 scares me - and here's why.

Experience with NPI

Just judging by the adoption of NPI (National Provider Identifier) numbers and the challenges it gave our billing service, ICD-10 code implementation has the potential to be very disruptive if a practice or billing service has not planned and prepared.

And NPI was only ONE number - ICD 10 codes are much more complex. Even if you and your provider are prepared, what about clearinghouses and insurance payers? Not to mention the largest insurance payer of them all - Medicare!

When our billing service incorporated NPI, we had the cost and disruption of upgrading our practice management software, coupled with having to re-map our claim files sent to the clearinghouse. There were also problems and confusion with some insurance carriers regarding legacy ID numbers, group NPI, and individual NPI.

This resulted in many claims not getting paid on the first submission - or second - or third... In some cases claims had to be re-submitted many times over. This was a major disruption to our clients revenue - and ours. And our clients are looking to us as a billing service to have all the answers.

As with NPI, we can expect that everybody will have a different interpretation of what implementing the new ICD 10 codes will require.

What sill it Cost?

What will the cost be to the small medical billing service? What will it cost our providers?

October 1, 2013 seams like a long way off - but we need to be learning, planning, and preparing for this transition now. I don't know if we have all fully grasped how much this will cost in direct and in-direct costs.

What I mean by direct costs are the time and money required for training, mapping ICD-9 to ICD-10, and potential costly software modifications. Indirect costs refer to interruptions to reimbursement for a providers - especially small ones. I have a feeling this is another unfunded mandate resulting from the 1996 HIPAA legislation thats going to cost all parties involved.

Brief Background of ICD 10 Codes

ICD-9 codes are nearly 30 years old and cannot be expanded any further diagnosis. Many of the diagnosis categories are full. ICD 9 codes are 3 to 5 characters. The first can be a number or letter, the 2nd through 5th are numbers with a decimal after the third character.

ICD 10 codes are 3 to 7 characters, the first one is a letter, 2nd through 7th are either a letter or number, with a decimal after 3 characters. These codes are arranged in chapters and sub-chapters with diseases grouped by letter. It allows over 155,000 diagnosis codes compared to a maximum of 17,000 ICD 9 codes.

Supposedly the greater number of codes in the ICD 10 will make it easier to find the right diagnosis code. ICD 10 has an improved structure and is more specific making it easier to use than ICD 9. Most practices use a relatively small number of codes related to the type of specialty.

Part of HIPAA

HIPAA legislation included the requirement for use of ICD 10 with a compliance date of October 1, 2013 to be implemented. The government agency requiring implementation is the Department of Health and Human Services (HHS). HHS has no plans to delay implementing.

Related to the switch to ICD 10 is the transition to the version 5010 standard for electronic transactions effective January 1, 2012. The 5010 changes are necessary to accommodate ICD 10 codes and NPI.

ICD-9 will no longer be maintained after implementation of ICD 10. ICD 10 is currently in use by other countries and is updated annually just like ICD 9.

Concerns

The issues of concern for most providers and those who serve them are the potential economic impacts. Will practice management systems be able to accommodate the greater number of diagnosis codes (up to 155,000) for ICD 10? Software applications from the front end physicians office to the clearinghouse to the payer will have to be able to accommodated ICD 10.

Will payers that don't yet use ICD 10 codes map everything back to ICD 9 for processing?

Estimates for healthcare providers, coders, and billers to become proficient with ICD 10 is 6 months.

From what I've read about ICD 10, it's an improvement to the current ICD 9 diagnosis codes, however the transition has the potential to be very disruptive. It seams like a long way off, but it's important to begin planning and preparing for this transition now.

Gina Wysor has over 10 years experience in the medical billing industry as well as an additional 10 years in the insurance industry. Gina is the owner of a home based medical billing and coding company, Advanced Reimbursement Solutions.

Visit http://www.all-things-medical-billing.com/ for more information on Medical Billing as a business or career. http://www.all-things-medical-billing.com/medical-billing-information.html has additional information on Medical Billing and some of the issues of concern to the Billing Specialist.

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