ICD-10 goes into effect for all HIPPA-covered entities as of October 1, 2015. The ICD-10 system replaces the ICD-9 code set which was developed in the 1970s. The ICD-9 system is being replaced because:
ICD-9 has become outdated and not as robust as needed by our modern-day healthcare system, thus resulting in inaccurate codes being assigned to performed procedures.
The ICD-9 system is actually costing the healthcare system amounts estimated in the billion dollar range for every year it remains in effect, according to the American Health Information Management Association (AHIMA).
The AHIMA further states that the United States is the only industrialized nation not using an ICD-10-based classification system.
While in the past there have been updates to coding standards, this transition is larger than other changes within the industry. Ken Bradley, vice president, strategic planning and regulatory compliance, Navicure, Duluth, Ga., recently had an excellent conversation with Medical Group Management Association for their MGMA Connection Magazine about these changes. In the article, when asked about how these changes are different from others in the past, he states that,
“A big difference with ICD-10 is the comprehensive transition from ICD-9 to ICD-10. As of Oct. 1, everything to everyone must be ICD-10-ready. For both practices and clearinghouses, this means we will suddenly be doing all new business under the new ICD-10 standards. Consequently, practices might be faced with two choices:
Sending claims at their usual rate with the potential for mistakes
Taking some extra time to ensure accurate coding on claims and potentially acquiring a backlog…”
Additionally, he states that clearinghouses might be able to help by working with a practice’s leadership to identify and provide solutions for a practice’s weak areas, offering short-term workarounds during the initial transition period, and checking for valid codes and diagnosis-specific requirements.
Lastly, Ken Bradley recommends comparing previous ICD-9 claims alongside new encounters coded with ICD-10, so practices can assess how well fee schedules match. Read the full article at MGMA.
The American Health Information Management Association has produced the following preparedness toolkits to help with the transition:
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