Transition from ICD-9 to ICD-10: CMS Will Reimburse Wrongly Coded Claims for One Year

Transition from ICD-9 to ICD-10
August 24, 2015

Posted by MedbillingExperts / 0 Comment

ICD-10 is one of the biggest and the most exciting change in standard healthcare coding systems in decades. By adding over 65,000 new codes that describes medical conditions and treatments, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) has completely revamped the healthcare landscape and in the process has transformed every system, process, and operation that uses a diagnosis code as we know it.

The most striking difference between the new ICD-10 version and ICD-9 codes that are widely used currently include revisions to the structure of the codes themselves. These changes in the structure and increased number of codes have greatly improved the quality of care and given rise to much greater specificity in the documentation of diagnoses that was unheard of previously. Ability to assign unique coding of inpatient hospital procedures so that events/actions can be freely differentiated and significant room for expansion, allowing for the code set to include new procedures and devices are some of the other pros of the new revision.

In spite of all the notable advantages many healthcare providers are still wary about the latest changes. Some like Texas’ state medical association, the largest in the country, have even questioned the need for such a transition, stating that complying with latest revision could cost them three times more than previous estimates. Growing concerns from medical practitioners that they would not be reimbursed if they make minor mistakes while trying to implement the more intricate ICD-10 billing system were adding fuel to the fire. All this has compelled Centers for Medicare & Medicaid Services (CMS) to go on the defensive and make some concession in the transition from ICD-9 to ICD-10.

In a bid to win the heart of the healthcare service providers and get them onboard, the federal agency has decided to soften its stands on the October 1st, 2015 deadline. As per the latest directive from the federal agency, the healthcare players will be reimbursed for incorrectly coded claims as long as that inaccurate code belongs to the same broad family as the correct one, for one year past the deadline. Though the majority of the industry rejoiced and welcomed this decision with open hands, experts such as American Health Information Management Association (AHIMA) were not so generous. They openly criticized the move and stated that this was not called for. This is because, they believed that CMS has already done ample outreach and preparation to help the industry in the transition.

The Road Ahead:

All healthcare practitioners should bear in mind that the Medicare claims processing systems will not accept ICD-9 codes for dates of services post September 30, 2015, nor will they be able to process claims for both ICD-9 and ICD-10 codes. Hence rather than burning your fingers trying to move form ICD-9 to ICD-10 on your own, opt to avail the services of outsourced service provider who can help you in this transition.

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