Medicare has had a slight increase in fees for services on or after July 1, 2015.
ICD9 to ICD10 Transition Myths and Facts
1. Myth- I do not have to worry about the transition as it has been delayed 3 times already. Fact- HHS has no plans to extend the compliance date for implementation of ICD-10-CM/PCS; therefore, covered entities should plan to complete the steps required to implement ICD-10-CM/PCS on October 1, 2015.
2. Myth – I can use ICD10 now. Fact-The date of service determines the use of ICD9 or ICD10. Any services delivered on October 1 or later use ICD10. If the date of service was in September, regardless if the claim is sent in October or later will require ICD9.
3. Myth-The changes also involve procedure coding. Fact- There are no changes or updates to CPT coding, ICD10 only updates diagnoses for outpatient settings. There is a procedure coding system in ICD9 and one in ICD10 however those are only used in hospital inpatient settings. ICD-10-PCS will only be used for facility reporting of hospital inpatient procedures and will not affect the use of CPT.
4. Myth- The ICD10 system will require claims have an external cause of injury code with all injury claims. Fact- Use of external causes of injury for ICD10 will not be required. There has never been a reporting requirement for external causes of injury, which is also a part of ICD9, unless there is a state mandate for reporting. For example in ICD9 there are codes that describe how an injury occurred, for instance E812.0 is a driver of an automobile involved in an accident with another vehicle. However, the description of the accident does not indicate any information pertaining the actual diagnosis or necessity of care as a result of the injury. In simple terms an automobile insurance carrier does not need a code that describes it was a car accident, as they know that already, but what is actually wrong with the person such as sprain, strain, neuritis, disc, etc.
5. Myth- Doctors of chiropractic will now be required to use potentially thousands of codes. Fact- There are indeed thousands of codes, ICD9 has over 13,000 and ICD10 has 68,000 but of those thousands a doctor of chiropractic generally uses no more than 50 ICD9 codes on a regular basis, and in fact 15-20 commonly. There will be more codes with ICD10 as they are more descriptive including left, right, disc region, spine region etc. however will likely be approximately three times as many. For instance Medicare in states that require a secondary neuromusculoskeletal diagnosis generally publish about 60-70 codes, for ICD9, that a chiropractor may bill and be paid for. These list in ICD10 are about 160-200 codes.
6. Myth- Workers’ compensation and auto insurance will not use ICD10 as they are non covered entities. Fact- Because ICD-9-CM will no longer be maintained after ICD-10-CM/PCS is implemented, it is in non-covered entities’ best interest to use the new coding system. The increased detail in ICD-10-CM/PCS is of significant value to non-covered entities. The Centers for Medicare & Medicaid Services (CMS) will work with non-covered entities to encourage their use of ICD-10-CM. Special Note –However, this is why the HJ Ross Digital Coding Manual will maintain a crossover between ICD9 and ICD10 that a provider can easily move and map forward or when necessary backward and have at their disposal both codes when necessary.
7. Myth- The increased number of codes in ICD-10-CM will make the new coding system impossible to use. Fact- Just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD-10-CM doesn’t necessarily make it more complex to use. In fact, the greater numbers of codes in ICD-10-CM make it easier for you to find the right code. For instance ICD10 makes a distinction between myalgia M79.1 and fibromyalgia M79.7 which ICD9 does not. 722.4 in ICD9 is disc degeneration but in ICD10 M50.31 is disc degeneration from C2-3 and C3-4, M50.32 C4-5, C5-6, and C6-7 and M50.33 is C7-T1. Clearly ICD10 has much more specificity and can indicate medical necessity more succinctly simply by the specificity of the ICD10 coding which should lead to fewer requests for information from the insurance carriers.
8. Myth- Unnecessarily detailed medical record documentation will be required when ICD-10-CM is implemented. Fact- As with ICD-9-CM, ICD-10-CM codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for use when documentation doesn’t support a higher level of specificity. As demonstrated by the American Hospital Association/American Health Information Management Association field testing study, much of the detail contained in ICD-10-CM is already in medical record documentation, but is not currently needed for ICD-9-CM coding.
9. Myth- ICD-10-CM-based super bills will be too long or too complex to be of much use. Fact- Practices may continue to create super bills that contain the most common Diagnosis Codes used in their practice. ICD-10-CM-based super bills will not necessarily be longer or more complex than ICD-9-CM-based super bills. Neither currently-used super bills nor ICD-10-CM-based super bills provide all possible code options for many conditions.
10. Myth- Medically unnecessary diagnostic tests will need to be performed to assign an ICD-10-CM code. Fact- As with ICD-9-CM, ICD-10-CM codes are derived from documentation in the medical record. Therefore, if a diagnosis has not yet been established, you should code the condition to its highest degree of certainty (which may be a sign or symptom) when using either coding systems. In fact, ICD-10-CM contains many more codes for signs and symptoms than ICD-9-CM, and it is better designed for use in ambulatory encounters when definitive diagnoses are often not yet known.