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8 Key Points about Medical Billing & ICD-10 Transition

August 13, 2015

ICD-10_clock_blueKeeping a practice running can seem like a herculean task. Throw into the mix new coding system of approximately 68,000 codes that needs to be learned and applied correctly for your specialty and it becomes no small wonder that the majority of healthcare facilities are ill-prepared for the transition to ICD-10. According to an ICD-10 physician readiness poll from Medical Economics, 62 percent of physicians are ill-prepared for the ICD-10 codes while preparing their medical claims. ICD-10 is coming and preparation for the October 1st compliance date must occur in order to not overwhelm medical billing staff functioning when the time arrives. Keep in mind the following information when preparing a plan for the transition for your medical practice.

Benefits to prepare claims with ICD-10 Codes!

1. Experience longer codes. ICD-10 codes will range from three to seven digits compared to three to five. Codes begin with a letter, except for “U.” 3 digit-codes have a letter and then two numbers that follow. There are exceptions, such as M1a, coding for chronic gout.

2. Even with substantial training in ICD-10 coding, there will be a decrease in productivity. A recent study was published in the Journal of Perspective in Health Information Management. It concluded that well-trained providers will take 54.4 percent longer with the ICD-10 coding system. Productivity lost is estimated at 30 to 50 percent.

3. According to a survey of approximately 1,000 providers, challenges to implementation are:

  • Other health initiatives (electronic health records): 51.5 percent
  • Quality reporting: 26.8 percent
  • Prior capital projects: 21.7 percent

4. A six month grace period has been established by policy makers for coding errors. Providers will not be penalized for mistakes in coding during this period of transition.

How to prevent ICD-10 rejections?

5. There is no way to make the jump from ICD-9 to ICD-11 without implementing ICD-10. ICD-11 has an anticipated release time in 2017. The United States cannot ignore ICD-10 and must transition to ICD-10 before implementing codes from the release of ICD-11.

6. Worldwide statistics on pandemics and global issues require world-wide implementation of ICD-10. The World Health Organization only supports ICD-10 at this time. European nations have used ICD-10 since the 1980s. The United States is “the only industrialized nation not using an ICD-10-based classification system for morbidity reporting,” according to The American Health Management Association.

Delaying ICD-10 Implementation could cost your medical practice lot of money!

7. The practice software must be able to submit ICD-10 codes. The older Version 4010 claim format is one software that cannot accept the new codes. Reach out to the vendors and find out about the flexibility of their software. Can they supply the necessary software? If not, options include:

  • Selecting a new software option.
  • Contracting with clearinghouse/billing service that can offer a “workaround.”
  • Ascertaining the ability for claim submissions via payer Web portals or on paper.

Implementing new software will take time to properly review, install and test. The other alternatives may be less efficient. Give yourself the time and resources needed to pick a solution that works best for the practice at this time.

8. Keep your coders on hand during the transitional period. Confirm that employed coders will be with the practice during this period. Vacation leave should be restricted during this period. If contracting professional coders, ensure their certification as ICD-10 proficient by a reputable coding association. If needed, find alternative coders or firms that can provide ICD-10 coders during the transition.

Delaying the inevitable transition will only add more pressure and create more inaccuracies during implementation. Review vulnerabilities and find the resources now to make the required transition.


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