Overview of ICD-10 Medical Billing

Overview of ICD-10 Medical Billing

Medical practices in the United States are now required to convert from the old ICD-9 coding system to the new ICD-10 format. This is part of the Health Insurance Portability Accountability Act (HIPAA) requirements. To cope with this transition, physicians and their medical staff must become familiar with medical billing and coding requirements of the ICD-10 system.

physicians billing serviceWhat is ICD-10?

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). This is a complete list of medical classifications designed by the World Health Organization (WHO). This list offers codes for symptoms, signs, diseases, abnormal findings, complaints, societal circumstances, and injuries.

Why Switch Systems?

The main reason to switch from ICD-9 to ICD-10 is because there are many limitations associated with the ICD-9 system. The ICD-9 codes have been around for more than 30 years, and they are outdated. The ICD-10 system integrates specific information about various medical conditions, and it goes along better with new billing systems and modern technology.

How does ICD-10 differ from ICD-9?

The primary difference between the ICD-9 codes and the ICD-10 codes are that the 10 set is expanded. The ICD-10 add two new positions, which make seven positions (compared to five Ambulatory Surgery Center Billingwith ICD-9). Another change from the 9th revision is that the 10th accounts for more specific diagnoses. The ICD-10 version allows medical providers to make references to body regions on the right or left side of the patient, which is a concept called ‘laterality.’ Also, this increases the number of characters in each code.

What can make Transition Easier?

There is no single bridge technique available to convert the old system to the new one. For medical facilities that must switch, the Centers for Medicare and Medicaid Services offers an overview of the ICD-10 protocol, along with many other online resources.

What is involved in the ICD-10 System?

ICD codes are used to classify inpatient procedures and diagnoses, and they are necessary for reimbursement of healthcare services. The changes brought on by ICD-10 code conversion will have an impact on medical policies, healthcare providers, medical facilities, and various payors. The new code set addresses usage of:

  • Clinical Modifications Diagnostic Code set (ICD-10-CM)
  • Procedure Coding System (ICD10-PCS)

How can I Plan for the ICD-10 Transition?

To prepare for ICD-10, a medical facility must consider communications, training, budgeting, staffing, vendors, IT systems, and business associates. To plan for the transition from ICD-9 to ICD-10, the healthcare facility should organize those responsible for implementation of the system and form appropriate leadership. Having a plan and timeline allows for smooth transition. For many practices, a big hurdle involves the vast new documentation requirements. The documentation efforts should begin early in the transition process.Surgery Center Medical Billing

What is involved in ICD-10 Training?

The training is a major part of the ICD-10 implementation process. One major point for concern involves acceptance that there is a difference between code set training and implementation training. Code set training offers detailed knowledge of the code sets to key staff members. This is crucial to the transition process.

Why is appropriate ICD-10 Coding Important?

ICD-10 is necessary because it:

  • Ensures appropriate benefit application and payment
  • Reduces the possibility of requests for health records
  • Reduces instances of medical records reviews
  • Helps the medical practice or healthcare facility handle increased detail needed for government programs, risk adjustment, quality measures, and incentive programs

MPMR is a top medical billing and coding firm that offers intensive ICD-10 support, medical practice management consulting and customized reporting. Call MPMR today for a complimentary consultation today!

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