February 18, 2014
Many of our students asked why we were teaching both ICD-9 and ICD-10 when they were unable to use ICD-10 until 2014. The main reason was that we believed that there was a huge benefit in dual coding. Dual coding is the process of coding every claim with both ICD-9 and ICD-10 codes. We also believed that this was (and still is) the best way to prepare for the implementation of ICD-10 later this year. We understand that it will be labor intensive to use both coding systems, but it will be a huge learning tool for your office. Let's say you take our ICD-10 class now and don't use the system again until implementation in October, you will surely forget some of the nuances of ICD-10. Another possibly more important reason is that ICD-10 requires increased anatomy and physiology as well as clinical documentation. By practicing dual coding over the next 6-months, you will better know what changes you have to make to your documentation for the upcoming ICD-10 implementation.
Another question we have received is, "Is ICD-9 going away?" The short answer is no. As we know, HIPAA covered entities will require ICD-10 codes on all claims with dates of service on or after October 1, 2014. What about submitting claims after October 1st with dates of service prior to October 1st? ICD-9 codes will have to be used. Also, what about non-covered entities? Since non-covered entities such as workman's compensation, liability insurance (i.e. auto), and disability insurance are not required to meet the October 1st deadline. We believe that not all carriers will be ready for the transition in 2014, thus you will have to use ICD-9 for these carriers. Non-covered entities can decide if they are going to change to ICD-10 at all. If they do not change to ICD-10, your office will have to decide whether to continue to use ICD-9 for their claims or to not see these patients any longer. Check with your non-covered entities and see if they are going to make the transition.
From our experience with past transitions, we can only assume that not all covered entities will be ready on October 1st. What does this mean for your claims? There will most likely be delays in payment. We recommend that every office contact their carriers, software vendor, and clearinghouse for their ICD-10 transition schedule. Also check to see when you will be able to transmit test claims with ICD-10 codes.
One huge downside to the transition to ICD-10 is that the field length for ICD codes will have to be increased, thus if you have computer based software (loaded onto your computer) as opposed to web based (cloud-based) software, you will most likely be given the option of upgrading or replacing your software. Start contacting your software vendor now regarding becoming ICD-10 compliant. Ask about the cost of a web based upgrade. Often the cost of the upgrade will be more expensive than switching to a web based system that upgrades automatically. Once the modifications and upgrades have been made, you will need to perform internal training and testing. Your software vendor can offer guidance and support. The final step is external testing with carriers and your clearinghouse to ensure data flows freely and without errors. Your practice management software vendor can offer advice about how to resolve any bugs or glitches during the transition.
Lastly, the Centers of Medicare and Medicaid Services (CMS) recommend 12 months of internal testing of the ICD-10 compliant systems and 11 months of external testing with carriers, software vendors, and clearinghouses. Offices need to make contingency plans in the event there are problems with carriers during the switch to ICD-10 codes.
In short, if experience is our teacher, many carriers and clearinghouses will not be ready; if they are not, you will most certainly need dual coding. What does this mean to your practice? Dual coding will be extra work and extra expense, but it will be worth it. You should start planning and budgeting for it now.
Liz Jones, MS, CMBS-I RMC is the Academic Director of the Medical Association of Billers. Liz is a motivated, results oriented international trainer. In the early 90s, Liz owned and operated a third party medical billing service in Las Vegas, NV. She has contracted with Medicare, the Veterans' Administration, medical practices, and hospitals internationally to educate staff in medical billing, coding, and reimbursement trends. Liz developed and published a hands-on resource guide to aid students in passing the Certified Medical Billing Specialist® exam. Liz may be reached at Liz.Jones@e-medbill.com