On October 1, 2015, the U.S. healthcare system implemented a new code set for diagnoses - the International Classification of Diseases, Tenth Revision, Clinical Modification, better known as ICD-10-CM. The ICD-10-CM codes will replace ICD-9-CM as the standard for specifying diagnoses in medical records and insurance claims.
The team at PracticeAdmin enhanced our Billing Manager software to support ICD-10-CM. In addition to adding the ICD-10-CM codes to our database, we also increased the number of diagnoses allowed per claim from eight to twelve
Q: How do I enter ICD-10-CM codes in Billing Manager?
A: The same way you enter ICD-9-CM codes in the Billing Manager. We redesigned the user interface to streamline searching and selecting diagnosis codes as well as expanding the number of diagnoses per claim to twelve.
Q: Does Billing Manager support dual coding?
A: Yes. For each claim, you are able to select either the ICD-9 or ICD-10 codeset. You are not able to submit both ICD-9 and ICD-10 on the same claim.
Q: Have you tested that payers will be able to process my claims and pay the same as they do with ICD-9?
A: Our testing process is with our clearinghouse partners and involves sending them claim files with ICD-10 codes to ensure that they can receive the claim and transmit it onto the payer. Whether a payer is able to adjudicate the claim and how they will pay is of course dependent on the payer. We always recommend contacting the payer directly with questions about which codes to use and payments.
Q: What about the payers that are not implementing ICD-10-CM?
A: Everyone covered by HIPAA must transition to ICD-10-CM - this is most payers and includes payers who do not deal with Medicare claims. However, if you have payers who will not be transitioning, you can continue to send them ICD-9.
Q: Codes change every year, so why is the transition to ICD-10 any different from the annual code changes?
A: ICD-10-CM codes are different from ICD-9-CM codes and have a different structure. ICD-9-CM codes are mostly numeric and are three to five digits. ICD-10-CM codes are alphanumeric and contain three to seven characters. ICD-10-CM is more robust and descriptive with “one-to-many” matches in some instances.
Q: Does ICD-10-CM replace Current Procedural Terminology (CPT) procedure coding?
A: No. The switch to ICD-10 does not affect CPT coding for outpatient procedures.
Q: Where can I find the ICD-10-CM code set?
A: The ICD-10-CM code set and the ICD-10-CM official guidelines are available free of charge at http://www.cms.gov/Medicare/Coding/ICD10/