There is a new sheriff in the town of codes for billing and it’s known as ICD-10 and well quite frankly the sheriff is not that new but understanding this system will take some time to get use to it.
THE BIRTH OF ICD-10:
Before ICD-10 there was ICD-9 which came around 1970 and stuck around for nearly 30 years.With its limited codes it started to prove a little bit inadequate as the medical world started progressing into more modern and advanced times.The recognition of ICD-9-CM’s increasing shortcomings came into light around 1990s when the National Committee on Vital and Health Statistics (NCVHS) reported to the Department of Health and Human Services that ICD-9-CM was failing to capture the continued advance in medical care.Another mention of ICD-9 beginning to fail can be found reported in NCVHS’s 1993 annual report referring to ICD-9-CM as rapidly becoming outdated and the need for ICD-10 as a better candidate for medical billing coding world. In 2003 NCHVS strongly suggested that the US begin the regulatory process for adopting ICD-10.
After the decision of ICD-10 implementation,the deadline for it kept being pushed back till last year in 2015 ICD-9 was finally replaced by ICD-10 and there came so many codes more specific to the growing world of health care.A grace period of 12 months was granted and CMS along with American medical association (AMA) made joint efforts to help physicians get ready for the dead line.Additional guidelines and information was released to answers provider community queries and for those 12 months following ICD-10 implementation. Medicare review contractors didn’t deny physicians or other practitioner claims as long as they used a valid code from the right family even if not specific ICD-10 codes were used and finally OCT 1st,2016 marked the end of that grace period.
SO WHAT DOES ICD-10 BRINGS TO THE TABLE?
Well for starters it does offer more detailed approach when it comes to capturing the ever evolving medical procedures and technology. Part of the charm is that using this system ensures a more systematic and meaningful design to actually help further the improvement of patient care quality with all the data it will help gather. With more specific codes available outcome of the care provided can be tracked especially regarding treatment complications and safety which can actually also help to highlight the relationship between providers performance and the patient’s condition. Using more accurate and specific codes will also have an impact on efficacy of treatment provided as it will help the providers with designing a more effectively tailored disease management plan for each patient. There will also be less room for coding errors because of this system being more logically devised.In Fact during the 1 yr grace period CMS reported that out of the 10 percent claims being rejected only about .09 percent were due to invalid ICD-10 codes.
THE ADVANTAGES OF ICD-10 IN A NUTSHELL:
ICD-10 as compared to ICD-9 provides a more sound base for reimbursement plans and well it’s no surprise as ICD-9 codes were not originally made to be used for reimbursement purpose. Payers, policy makers and providers equally benefit from ICD-10 because its very specific and can especially help with the pay for service programs.ICD-10 identifies each procedure uniquely whereas in past there was not a very fine line between conditions that supported medical necessity for a particular service or conditions that did not justify the service and both cases were sometimes being defined by the same code.
2.IDENTIFYING BEHAVIORAL RISK.
Just above i have talked about different conditions affecting services differently for the same specific area of specialty’s what does that mean? It actually means that every patient and their behavioral risks are different. Smoking history, lack of exercise, dietary habits and difference in lifestyle can all be more clearly outlined and identified with the help of ICD-10 as compared to ICD-9 and a detailed claim can be made.
3.KEEPING UP WITH INFORMATION TECHNOLOGY IN HEALTH INDUSTRY.
When it comes to IT in health industry ICD-9 was not doing a very well job and was turning out to be vague and ambiguous. In the age of automation ICD-10 provides a better means of acquiring data in electronic format making it easy to retrieve, exchanged or utilized for comparison studies and research. CAC ( computer assisted coding) makes administrative reporting process more consistent and accurate as compared to clinical mapping done using SNOMED CT( terminology used to define clinical detail of a care episode) based on ICD-9 codes.
4.DEALING WITH FRAUDULENT CLAIMS and LAWSUITS.
Well lets just face it a few dishonest providers have taken advantage of the vague system of ICD-9 in the past so another advantage is that ICD-10 being more specific and diverse can help with detecting and catching fraudulent claims with very less grey area available to be manipulated and utilized for fraud by some opportunistic practices. On the other hand it also empowers the provider in terms of keeping all their bases well covered with detailed and organized documentation and keeping facts well visualized in face of a lawsuit by a patient.
ICD-10 can really help with clinical research as it helps ensure that data required for the research is available in more specific and accurate form and it can also help to identify and keep record of all aspects of a condition unique to it.
6.BENEFIT FOR THE CONSUMER.
For consumer it is beneficial in the sense that it helps to educate them about the outcome and cost of treatment options and how it is or can be planned custom made to their needs.
WHAT TO EXPECT AND HOW TO MANAGE POST ICD-10 IMPLEMENTATION:
With the implementation of ICD-10 practices submitting unspecified ICD-10 codes after October 1, 2016 may potentially experience an increase in claims rejections. Also, it will be very challenging to keep up with the excess of new codes available and to maintain a very consistent reporting based on all those new codes. However, to avoid falling short in these challenges a few things can be done.
1.With all those increased number of codes available it is very necessary to become familiar with codes particular to your specific specialty and review and focus on more relevant codes. This also involves reviewing the already present codes in your billing system so you can be more specific.
2.Use the ICD-10 system as a tool to help keep your claims from being rejected and utilize the specific information available to your advantage in capturing complexities of each individual case due to different life style factors involved.
3.Monitor your claims and unpaid charges closely and figure out the relationship between gaps in information and inconsistencies in the codes used and be more vigilant about it for future claims.
4.Last but not the least In my humble opinion a very professional approach to achieve all this can be done by hiring a credential coding professional who can help evaluate the software errors or glitches and help identify specific code assignment.
Whether providers like it or not ICD-10 is here to stay as we all move into the modern times regarding medical care so moving forward and getting better acquainted with it is the logical choice to do so that everyone can actually benefit from it and use its full potential.