As of October 1, 2015, FFS (fee for service) Medical Claims will require ICD-10 codes for disease documentation in lieu of ICD-9 codes.
As noted in this July 7, 2015 letter to providers from CMS Administrator Andrew Slavitt , no claims submitted after October 1, 2015 will be processed unless diseases are documented with ICD-10 codes. And as usual, private insurers are following CMS’ lead and are requiring ICD-10 documentation for their claims as of October 1.
On the surface, going from approximately 16,000 ICD-9 codes to 68,000 ICD-10 codes seems daunting.
The good news is that there are simple tools to deal with this transition such as an ICD-10 SNOMED (Systemized Nomenclature of Medicine) conversion license which will take all of your patients ICD-9 codes and assign comparable ICD-10 codes .
Once patients’ existing diagnoses are converted using the SNOMED conversion script, the medical claim billers should be able to obtain a report that details any patient diagnoses that cannot be mapped directly to ICD-10 codes with suggestions for the correct code.
There are also web sites such as icd10data.com which a biller can use to convert current ICD-9 codes to the closest ICD-10 equivalent. CMS has extensive ICD-10 transition information on their informative “Road to 10” web site.
More good news is that CMS is not requiring the perfect match for ICD-9 to ICD-10 code conversion. They have promised that as long as the ICD-10 code is “within the same family, “ the ICD-10 code and claim will not be rejected.
The bottom line is that ICD-10, like Meaningful Use, PQRS, ACO’s, ACA’s, VBM, etc., is not going away. But as in most cases, the solution to the problem does not require brain surgery, but it does require not burying your head in the sand.
Suresh Bhatia is a Medical Practice Consultant (emr-dr.com). Suresh was previously a CFO/Practice Administrator for a Beverly Hills medical practice and a Vice President of Operations for a Southern California IPA.