With less than two months left before the extended ICD-10 implementation deadline of October 1, 2015, many dermatological practices are still grappling with making the transition from working with approximately 9,000 codes to over 22,000 codes when the code requirements will change – literally – overnight.
Officially known as the International Classification of Diseases, 10th Revision Clinical Modification (CM) is mandated for use by all practices covered by HIPAA. (The other form of ICD-10, PCS, is for inpatient procedures, as in hospitals, so will rarely be used by most dermatology practices.)
ICD-10 answers the need for more accurate coding
Dermatology practices require that coders be familiar with the latest codes for biopsies, phototherapy, lesions, excisions and related procedures and diagnoses to ensure clean claims that will be payable under the latest regulations. Thanks to numerous advances in healthcare, the result is the need for more specific codes, with most of the changes in the structure, organization, composition of codes and the amount of detail, and which will permit wider expansion for future modifications.
Due to the frequent lack of specific ICD-9 codes many dermatology claims were rejected, necessitating appeals or even audits. This created billing headaches for billing and A/R departments as well as loss of practice revenues.
Using the diagnosis for acne, for example, under the old system of ICD-9, coders would have had just one code, 706.1. No further coding information was available to describe what type of acne, whether vulgaris, conglobata, tropica, and so on.
ICD-10 will now give providers eight codes for describing acne conditions, each with its own character to specify the anatomic location, etiology and laterality. The new codes include the above conditions now listed as:
- L70.0 Acne vulgaris,
- L70.1 Acne conglobate,
- L70.3 Acne tropica.
Although there are potentially up to seven characters available in ICD-10, depending on the condition, most dermatological conditions will need only six characters.
How will you know if your dermatology practice is ready for ICD-10?
Most practices should have taken advantage of the extended deadline to upgrade billing software and other necessary technologies, as well as training billing and coding office staff to use them. With the creation of over 55,000 codes and the deadline fast-approaching, you need to assess your practice’s implementation readiness. By now, practices should have completed the following:
- Learned the fundamentals of the coding structure as well as ICD-10 CM.
- Understand the General Equivalency Mappings
- Share implementation plans and information throughout the practice or organization
Ideally, practices should be in the final stages of testing their updated systems to ensure deadline compliance. The following factors should be included in tests:
- Insurance and eligibility verification
- Any other processes involving ICD-10 coding
It’s important to test not only within the practice’s system but with vendors, IT personnel, coders and other staff users, as well as payers or clearinghouses.
Why medical billing outsourcing makes sense for dermatology practices
For those practices which may have fewer staff available for billing or coding or whose budgets preclude extensive technological outlays, consider partnering with and outsourcing medical billing and coding to an experienced third-party service using the latest technology by experienced claims personnel.
Practices can be confident that ICD-10 coding, HIPAA, bundling and contractual adjustments, medical necessity documentation, Meaningful Use and other compliance requirements are fully met, leaving business department staff to handle other aspects of A/R.
Since 2002, M-Scribe has been assisting dermatology practices of all sizes with their billing and coding needs, as well as all phases of revenue cycle management. Contact them at H.Gibson@m-scribe.com or at 770-666-0470 for a complimentary consultation to learn how M-Scribe can improve practice revenues while ensuring full compliance.