Medical Billing Coding - ICD-10-CM, cpt, codes
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Thread Topic: ICD-10-CM
Topic Originator: Steve Verno
Post Date May 12, 2011 @ 12:24 PM

Steve Verno
May 12, 2011 @ 12:24 PM Reply  |  Email Friend   |  |Print  |  Top

It is now May 5, 2011.  You have between now and December 31. 2011 to be completed with ANSI 5010 testing with Medicare.  

ANSI 5010 is the new HIPAA code set for ICD-10.  Pretty soon October 1, 2013, the effective date for ICD-10 will be here.  

Some things to do:

1)  Contact your software vendor and your clearinghouse to find out what they are doing to help you get ready for ICD-10.  
Your software will need to be able to contain both ICD-9 AND icd-10.  Why?
Mr. Magoo is seen on May 5, 2013.  He provides NO health insurance.  You treat him as a self pay or uninsured patient.  His debt is sent to your debt collection agency in September 2013.  In May 2014, Mr. Magoo is angry because he has ABC Insurance and he blames you for sending him to your collection agency.  He says YOU DIDNT DO ENOUGH TO CONTACT HIM OR ASK HIM ABOUT HIS INSURANCE., eben though you sent him a printed statement each month for 3 months and on the statement it tells him to contact you if he has insurance to pay for the medical care.  It doesnt matter because YOU DIDNT DO ENOUGH!  His lawyer sends you a letter directing you to (a) remove his clients account from collections, (b) remove all credit entries so that Mr. Magoos' credit rating can be restored, and (c) send the claim to Blue Cross (even though the time limit to send a claim is long gone).  ABC says they will accept the claim.  Why?  State statute says the provider has 6 months from the date of service AND from the date when YOU received the correct insurance information.  It is May 2013, so the clock starts now because today is when you received the correct insurance information, BUT, this may not stop ABC from denying the claim.  Mr. Magoo was seen when ICD-9 was the authorized and approved code set.  ICD-10 wasnt effective in May 2013, so you need to send the claim using ICD-9 codes.  Rather than send the claim to the claims processing address, you might be better sending the claim to the corporate office, to the attention of the CEO, with a cover letter explaining the circumstances.  

2.  Start training your doctor to document the visit better.  Some ICD-10 codes are anatomically specific.  For example. ICD-9 code 414.01, Coronary atherosclerosis; of native coronary artery, has almost 150 ICD-10 codes which relate to anatomy to find the code that best fits the anatomical condition.  Fever, ICD-9-CM code 780.6 has nine possible codes under ICD-10, so you need to know which type of fever the patient is presenting.  
3.  If your coders are AAPC certified, they will be required to undergo retesting under ICD-10 for recertification.  If you have coders without training or certification, then it is highly recommended they are sent for training and certification.  Trained coders should not have any problems with ICD-10,  the untrained wont understand it. Having untrained coders, code using a cheat sheet or forum wont work.  One ICD-9 code has a possibility of 150 ICD-10 codes.  The cheat sheet may not have been designed by a trained and certified coder, so do you wish to take that chance?  Although medical billers are not coders, they do need to have knowledge of the basics of coding.  This knowledge of the coding basics is used when appealing a claim denial unless you have your coding department appeal coding denials.  Again, the untrained may not have the knowledge or experience in appealing a claim denial under ICD-10.  Some practices place the spouse or receptionist into the billing department to fill the void.  Being a spouse or receptionist does not make a medical biller.  Ive been to at least 10 practices recently where the doctor is having severe financial issues.  In each practice, the coder and biller is the doctors spouse or the receptionist who had some experience calling an insurance company to verify coverage.  
4.  be vey careful with scare tactics being used by some companies to get you to attend their ICD-10 seminars.  One call I received recently told me that it is mandatory to attend their ICD-10 seminar to be certified in ICD 10.  If I didnt attend, our claims would be denied by the insurance company.  Ive been to these types of scare tactic seminars.  They are there to get you to buy their books, which are wrapped in plastic.  If you remove the plastic in the seminar, you void any chance of a refund.  When the seminar ends, the nice old lady taking your money and the speaker get into their 1975 Gremlin and they hightail it out of the area, only to appear at a different hotel for tomorrows seminar and victims.  When you do open the plastic, you have a copy of a copy of a copy of a copy of a cheap manual.  You find that you dont have the names of the people who were at the seminar so you can get your money back.  In the old west, this couple would be known as snake oil salesmen.  NOT ONE INSURANCE COMPANY, INCLUDING MEDICARE, HAS MADE IT MANDATORY FOR YOU TO ATTEND AN ICD-10 SEMINAR SO THAT YOUR CLAIMS CAN BE PAID.!!!  THERE IS NO GOVERNMENT LAW, STATE OR FEDERAL THAT MAKES THIS MANDATORY!  You are free to attend any advertised ICD-10 seminars, at your own expense if you wish to learn about ICD-10.  I would recommend those offered by the MAB, AAPC, PAHCS, or POMAA, but especially the MAB.  Im personally working on some ICD-10 guides for some specialties which take their top 10 ICD-9 codes and showing the ICD-10 counterpart.  Ive done them for emergency medicine, public health and a few others.  I make no money off of these.  They are free to the MAB.  I am not the expert in ICD-10 but I have been looking at the codes for 3 years now.  Ive seen and read the guidelines.  Ive also created a guide to help you get ready for ICD-10.  This too is free and available to the MAB for free.  You can email me at  (steve_verno) for your copy. All I ask is you do not put your name on it and distibute it under your name or to sell it.  I do not ask you for any information on yourself, nor do I ask you for any form of payment.  If you would like a free guide for your specialty, just email me your top 10 icd-9 codes and your specialty. Give me 2 weeks and you will get the guide for free, understand that I own the copyright and intillectual property rights to the completed guide.  The WHO owns the copyright to the ICD-9 and ICD-10 codes.  Ive sent 2 new guides to Storm at BC Advantage (Cardiology and Public Health and now working on Family Practice & Pediatrics)  

Believe it or not, October 1, 2013 will be here before you know it.  As the boyscouts say, Be Prepared!  Start now by getting ready.  The MAB is here to guide you.

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