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ICD-10 and Your Practice

What is ICD-10?

ICD-10 is the acronym for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. As of October 1, 2015, ICD-10 will replace the current ICD-9 codes, and ICD-9 codes will no longer be accepted. All HIPAA covered entities must make the change.

HIPAA covered entities include: 

  • health care providers that are required to send or accept electronic transactions
  • clearing houses
  • health plans

HIPAA covered entities attempting to use ICD-9 codes on or after October 1, 2015 will find that their claims will be denied without payment. 

ICD-10 codes contain up to seven alpha-numeric characters while ICD-9 codes only contain up to 5 characters.  Each character represents a component that describes the medical treatment or procedure in detail.  There are 35 possible values for each character:  the digits 0-9 and all letters except the letter “U”. 

Why are we moving to ICD-10?

The expanded length of ICD-10 codes enables them to convey more specific information.  The system will be easy to expand and the codes’ structure makes them easier to analyze.  While there are approximately 13,000 ICD-9 codes, there will be more than 68,000 ICD-10 codes.

The improvements brought about by the change from ICD-9 to ICD-10 include: 

  • the addition of information regarding ambulatory and managed care
  • expanded injury codes
  • combined diagnosis/symptom codes to better describe medical conditions
  • greater specificity overall

For example, the new ICD-10 codes will allow for increased detail related to a finger amputation procedure.  Under ICD-9, there is just one code for finger amputation regardless of the digit involved and the level of difficulty associated with the amputation.  With ICD-10, there are distinct codes for each finger and each section of each finger, which allows the insurance company to determine the proper payment to remit for the procedure. In addition, the new ICD-10 codes facilitate the tracking of mortality rates in conjunction with the specific diagnosis.

How can the transition to ICD-10 impact my cash flow?

The Centers for Medicare and Medicaid Services (CMS) estimates that in early stages of implementation, denial rates will rise by 100 to 200 percent, and that days in accounts receivable will grow 20 to 40 percent. Switching to ICD-10 can cause an increase in payment delay for a practice because of the challenges of claims processing.  Without the proper training and preparation for ICD-10, a practice can face significant problems with time when it comes to reworking denied claims.

Will CPT codes change as well?

No, practices will not see changes to their CPT codes with ICD-10 beyond the normal annual changes.

How can GroupOne Help?

ICD-10 has been delayed but GroupOne is still ready. GroupOne's certified professional coders are fully trained on ICD-10 and can help your practice have a successful transition. The ICD-10 delay will not deter us from our goals to improve the overall level of documentation that will in turn improve the quality of data that will result in improved patient care and happy, successful clients.  ICD-10 training will be provided to all GroupOne revenue cycle management clients at no additional charge.  Contact us at services@g1hs.com for more information on how GroupOne is approaching the transition to ICD-10.

Prepare for ICD-10