International Classification of Diseases, 10th revision; simply put ICD–10 (the full form does put a separate ring to it!!!) is set be implemented in October 2015 and there is no better time than now to understand what it means and how it is going to affect the physicians. The most important aspect they need to understand is that this change is necessary. The reason being ICD–9 covers limited medical conditions and hospital procedures. Moreover it is about 30 years old with terms that now seem outdated and is not consistent with the current medical practice. Furthermore, the structure of ICD–9 is such that it restricts the growth of number of codes, and many categories under ICD–9 are already full.
5 Things Physicians Should Note
Let us look at five essential things physicians should absolutely be aware of:
Firstly, physicians should be mindful of the fact that ICD–10 will not replace CPT codes. While ICD–10 codes are for diagnosis, CPT codes are for billing, with both these items being mentioned on the claim. The transition to ICD–10 will not affect the CPT coding for outpatient procedures. Just like ICD–9 procedure codes, ICD–10 PCS codes are for inpatient procedures only.
Secondly, anyone and everyone covered by HIPAA will get affected by ICD–10 and is not restricted to only those who submit Medicare or Medicaid claims. Rehab therapists, providers, payers, clearing houses, billing services, all of them will be affected by ICD–10. To put it simply, those under the purview of HIPAA will have to embrace ICD–10.
Thirdly, physicians need to up their game. Well, preparing for 68,000 diagnosis codes does sound daunting. However, it must be done and this requires an action plan. An implementation strategy needs to be prepared where an assessment of the organization can be made. A detailed timeline should be prepared and a budget earmarked. Simultaneously, the physicians should start taking active interest in their billing partners, clearing houses, vendors and others to check their implementation and compliance plans. If physicians are doing the billing internally, they need to make sure that the coding, IT and finance staff are well updated and trained.
Fourthly, ICD–10 requires far more details with regards to the location of an injury or condition. Hence, physicians must take every care to vet the codes properly; especially those pertinent to their specialty.
Finally, mentioning the correct code will be absolutely vital. Probably using a certain code which covers the basic treatment might get the physicians their reimbursement. However, there might be a more specific code which is comprehensive and appropriate and would result in a higher level of compensation. Hence, the billers and coders need to be aware of the codes to extract maximum reimbursement.
It would be in the best interests of physicians if physicians choose to partner with professional billing companies who have an expertise in code mapping, coding & end to end ICD-10 implementation. These billing companies come with an assurance that productivity will not be hampered during and after the transition & physicians will observe a smooth & flawless ICD-10 transition.