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The new ICD-10 codes will be implemented by payers on October 1, 2015.  If you do not use the proper ICD-10 codes as of this date claims will be denied and you will not get paid until the correct codes are submitted. There are over 70,000 codes to pick from.

If the episode of care is prior to and extends after October 1st then the codes will be ICD-9 through September 30th and change to ICD-10 on/after October 1st.

The reasons for going to ICD-10:

  • To improve the explanation of the patient’s condition
  • To improve claims analysis
  • Improve data collection for research

Please review this planning guide made available from CMS.   http://cdn.roadto10.org/wp-uploads/2014/02/Road_To_10_Implementation_Guide.pdf 

List of helpful ICD 10 conversion tools:

If you do not already have a plan, formulate one ASAP.  Below is a list to help with this task:

  • Obtain access to ICD-10 codes (code books and online)
  • Contact your payers to ensure they will be ready October 1st and see how many characters they require in ICD-10 coding.  Do they prefer the full 7 character codes if it is appropriate or fewer?  If their standards are exceeded will the claim be rejected?
  • Contact your clearinghouse for specific instructions 

Train Your Staff

  • Access the available sites with all the ICD-10 training resources:  ICD-10 Website; Road to 10; CMS e-mail updates
  • Identify top codes. What ICD-9 diagnosis codes does your practice see most often?  Target the top 25 to start.  You might want to look at common diagnosis available from CMS Road to 10

Update Your Processes

  • Resolve any documentation gaps identified while coding top diagnosis in ICD-10
  • Make sure clinical documentation captures key new coding concepts (if applicable):
  • Laterality – left versus right
  • Initial or subsequent encounter for injuries
  • Type of visit (eval vs follow up)
  • Specific body part
  • Dominance
  • Comorbidities 

Test Your Systems and Processes (double check with outsourced billing)

  • Confirm with your clearinghouse what payers are testing
  • Code and submit claims with ICD-10 coding

Documentation must support the ICD-10 selected.  You must document laterality, if this is the dominant side, when the event happened, where it happened, as well as if the patient is under the care of a physician for the injury.  

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