ICD-10 TransitionSeptember 2015

Modern History of ICD-10

The World Health Organization’s (WHO) International Classification of Diseases has served the healthcare community for over a century.

The United States implemented the current version (ICD-9) in 1979. While most industrialized countries moved to ICD-10 several years ago, the United States is just now transitioning with a final compliance date of October 1, 2015.

ICD-10 serves as a building block that allows for greater specificity and standardized data that can:

Improve coordination of a patient’s care across providers over time

Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events

Support innovative payment models that drive quality of care

Enhance fraud detection efforts

Main Highlights

ICD-10 Basics

ICD-10 consists of two parts: ICD-10-CM diagnosis coding which is for use in all U.S. health care settings.

ICD-10-PCS inpatient procedure coding which is for use in U.S. hospital settings.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims:

Claims for services provided on or after the compliance date should be submitted with ICD-10 diagnosis codes.

Claims for services provided prior to the compliance date should be submitted with ICD-9 diagnosis codes.

The change to ICD-10 does not affect CPT coding for outpatient procedures.

ICD-10CM Code Structure

ICD-10 diagnosis codes have between 3 and 7 characters:

Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of any or all of the 4th, 5th, and 6th characters. Digits 4-6 provide greater detail of etiology, anatomical site, and severity. A code using only the first three digits is to be used only if it is not further subdivided.

A code is invalid if it has not been coded to the full number of characters required. This does not mean that all ICD-10 codes must have 7 characters. The 7th character is only used in certain chapters to provide data about the characteristic of the encounter (such as injuries and fractures).

Westlake Dermatology Implementation

EMA will suggest the appropriate ICD-10 code as it has previously with ICD-9.

Once the note is finalized, those codes will transmit to NextGen for billing. Anuj performed testing in June with EMA and the NextGen bridge.

RCM (billing) is also prepared for the transition and will submit “dummy” claims with the payers to ensure the claim correctly flows through the clearinghouse to the payer.

We created a ICD9 – ICD10 conversion table for reference (based on the dx codes which were listed on our superbill). Will post to staff website and can be used for reference when filling out lab orders / standing orders.

ICD-9 to ICD-10 Conversion Examples

CPL Standing Orders

CPL has begun auditing their standing order records and if a standing order is on file with an expiration date after October 1st, they may fax the order to the office to provide the correct ICD-10 codes. Refer to conversation table for assistance.

If filling out a standing order between now & October 1st, best practice would be to include both codes on the form.

Currently do not have a set date on when new client materials will be available for ordering/distribution.

Westlake Dermpath Updates

We added the new ICD-10 code for 238.2 in the lab requisition form this week (D48.5)

Both ICD-9 and ICD10 codes will populate on the lab form during this interim period but only ICD-9 (238.2) will transmit for billing purposes

We will update after business on September 30th to have D48.5 submit for billing purposes.

Billing Q & A

What happens if I use the wrong ICD-10 code, will my claim be denied?

12 months after ICD-10 implementation, Medicare will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either as long as the physician/practitioner used a valid code from the right family.

A valid ICD-10 code will be required on all claims starting on October 1, 2015. It is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons.

Will reimbursement be affected? Reimbursement for outpatient and physician office procedures will not be determined by

ICD-10 codes. Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing.

However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today.