ICD-10 Myths and Facts: Part 1

ICD-10 RedTo provide the most up-to-date ICD-10 facts, CMS spoke with providers to identify common misconceptions about the transition. They published the top 10 facts in a two-part newsletter - Five Facts about ICD-10 and Five More Facts about ICD-10. In our two-part blog series we will examine each of these facts and add some additional commentary:

1. The ICD-10 transition date is October 1, 2015. 

The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10.

  • eMDs Insight - The last big hurdle to a 2015 transition to ICD-10 happened April 14th when the Senate overwhelmingly approved the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This was the last legislative opportunity for Congress to postpone the delay.While it is true that Texas Representative Ted Pope has introduced a bill, H.R. 2126, to the Committee on Energy and Commerce and the Committee on Ways and Means to prohibit the implementation of ICD-10, the committee is unlikely to act on the bill.

2. You don't have to use 68,000 codes.

Your practice does not use all 13,000 diagnosis codes available in ICD-9. Nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes.

3. You will use a similar process to look up ICD-10 codes that you use with ICD-9.

Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.

  • eMDs Insight – If you are manually looking up ICD-10 codes or going to a site for lookup assistance, make sure you plan plenty of time to manage the new code set. The process might remain the same, but the time to review the new code results will slow you down. Having an ICD-10 lookup tool that integrates with your practice management system will give you speed and accuracy after the transition so you can keep it "business as usual."

4. Outpatient and office procedure codes aren't changing.

The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of CPT for outpatient and office coding. Your practice will continue to use CPT.

  • eMDs Insights – More than 500 CPT changes were implemented in 2015. 266 new codes were introduced, 147 deleted, 129 revised and several guidelines were changed. It is as equally important for your practice to review and stay up-to-date on these changes, as it is to prepare for ICD-10. Visit the eMDs CPT Code Changes – 2015 resource page or a full review of the changes and updates.

5. All Medicare fee-for-service providers have the opportunity to conduct testing with CMS before the ICD-10 transition. 

Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure you can submit claims with ICD-10 codes. During a special "acknowledgement testing" week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.

  • eMDs Insights - During the week of July 20 through 24, 2015, a final sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing. Approximately 850 volunteer submitters will be selected to participate. CMS intends to select volunteers representing a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers. CMS is accepting additional volunteers through May 22.  Notification of selection status will occur by June 12, 2015. Those selected will be provided specific details regarding how to test and who to contact for testing support.

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