ICD-10 Impact on Orthopedic Billing Services

The far-reaching effects of ICD-10 will have to be understood by all in healthcare in order to deal with the impacts.

The ICD-10 coding system that will kick in on October 01, 2015, is stated to be more comprehensive and much more advanced than its predecessor ICD-9. It is a known fact that Orthopedic and General Surgery billing practices are not just highly complex, but are known to cover a greater scope of services and procedures as compared to other medical specialties.

Besides, loss in productivity and practice revenues, some of the major impacts that ICD-10 will have on Orthopedic billing services are:

Revenue Cycle Management:

Failing to keep up with changing payer rules and fees schedules can have a negative impact on the revenue cycle processes. It has been stated that nearly 25 percent of medical claims show rejection of which 15 percent are never resubmitted.

Clinical Documentation:

Accurately documenting along with selecting appropriate ICD-10 codes that support diagnosis reporting and the medical necessity for the service provided is very much required in the new coding system. This will take more investment in terms of time. According to the Medical Group Management Association, the time required for documentation will increase by at least 15 percent.

Time investment:

Coders and billers will need additional time to verify that the codes support the documentation and vice-versa. Moreover, during the first 6 months after the ICD-10 coding system kicks in, reviewing rejected or/and denied claims, will be time-consuming. It has been stated that the transition change will slow the billing process by as much as 50 percent which will necessitate hiring more staff to do the same amount of coding.

Financial investment:

In addition to time investments, orthopedic practices will also have to incur costs for updating electronic claims submission procedures under HIPAA from American National Standard Institute (ANSI) 4010 to ANSI 5010, which might already be underway.

Medicare patient billing:

The greatest impact and challenge that orthopedic practices will encounter with the introduction of the ICD-10 coding system will be the billing of Medicare patients. Orthopedic treatment for Medicare patients includes billing of Durable Medical Equipment (DME) which is different from being billed for physician services. Thus, billing for both will involve separate ICD-10 codes for both Medicare Part A and Part B claims.

But before orthopedic practices start billing the DME services for Medicare patients, one needs to be aware of the 2 Federal laws, the Medicare/Medicaid Anti- Kickback Statute and the Stark Act. DME billing can bring in a large revenue, but the amount varies with product and state.

So if your orthopedic practice cannot dispense Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), see to it that you can arrange to have a Durable Medical Equipment Regional Carrier (DMERC) license to dispense covered items for Medicare patients and you can start making profits.