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MEDICAL BILLING NEWS
ICD-10 Code Set to Replace ICD-9
The differences between ICD-9 and ICD-10 are significant and physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the October 1, 2013 compliance deadline.
ICD-10-CM codes are the ones designated for use in documenting diagnoses. They are 3-7 characters in length and total 68,000, while ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000. The ICD-10-PCS are the procedure codes and they are alphanumeric, 7 characters in length, and total approximately 87,000, while ICD-9-CM procedure codes are only 3-4 numbers in length and total approximately 4,000 codes.
Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, as well as other necessary investments.
Before the ICD-10 codes can be used however, physicians and others in the health care community must start using the new version of HIPAA transaction standards known as 5010 by January 1, 2012, as the current version, 4010, does not accommodate use of the ICD-10 codes.
ICD-10 FAQ:
What is “ICD-10”?
“ICD-10” is the abbreviated way to refer to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).
Explain the difference between ICD-10-CM and ICD-10-PCS.
ICD-10-CM is the diagnosis code set that will be replacing ICD-9-CM Volumes 1 and 2. ICD-10-CM will be used to report diagnoses in all clinical settings. ICD-10-PCS is the procedure code set that will be replacing ICD-9-CM Volume 3. ICD-10-PCS will be used to report hospital inpatient procedures only.
Will ICD-10-PCS replace CPT®?
No. ICD-10-PCS will be used to report hospital inpatient procedures only. The Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) will continue to be used to report services and procedures in outpatient and office settings.
Do I have to upgrade to ICD-10?
Yes. The conversion to ICD-10 is a HIPAA code set requirement. Providers, including physicians, are HIPAA “covered entities”, which means that you must comply with the HIPAA requirements.
Who else has to upgrade to ICD-10?
Health care clearinghouses and payers are also HIPAA covered entities, so they are required to convert to ICD-10 as well.
I thought HIPAA code set standards only applied to the HIPAA electronic transactions. What if I don’t use the HIPAA electronic transactions?
It is correct that HIPAA code set requirements apply only to the HIPAA electronic transactions. But, it would be much too burdensome on the industry to use ICD-10 in electronic transactions and ICD-9 in manual transactions. Payers are expected to require ICD-10 codes be used in other transactions, such as on paper, through a dedicated fax machine, or via the phone.
Why is ICD-9 being replaced?
The ICD-9 code set is over 30 years old and has become outdated. It is no longer considered usable for today’s treatment, reporting, and payment processes. It does not reflect advances in medical technology and knowledge. In addition, the format limits the ability to expand the code set and add new codes. Also, the Medical Conglomerate wants to make more money by forcing the hard working Doctor and his staff to spend more administrative time and money trying to comply with Medicare' s ridiculous demands.
The ICD-10 code set reflects advances in medicine and uses current medical terminology. The code format is expanded, which means that it has the ability to include greater detail within the code. The greater detail means that the code can provide more specific information about the diagnosis. The ICD-10 code set is also more flexible for expansion and including new technologies and diagnoses. The change, however, is expected to be disruptive for physicians during the transition and you are urged to begin preparing now.
When do I have to convert to ICD-10?
All services and discharges on or after October 1, 2013 must be coded using the ICD-10 code set. The necessary system and workflow changes need to be in place by the compliance date in order for you to send and receive the ICD-10 codes.
What if I’m not ready by the compliance deadline?
Then you are SOL! Any ICD-9 codes used in transactions for services or discharges on or after October 1, 2013 will be rejected as non-compliant and the transactions will not be processed. You will have disruptions in your transactions being processed and receipt of your payments. Physicians are urged to set up a line of credit to mitigate any cash flow interruptions that may occur.
Deadlines for other HIPAA requirements have been delayed. Will the compliance date for ICD-10 be delayed?
Do not expect there to be a delay in the ICD-10 compliance deadline. The Centers for Medicare & Medicaid Services (CMS) is responsible for oversight of compliance with the HIPAA code set requirements. CMS has made it clear that there will be no extension of the deadline for ICD-10. Work within Medicare to upgrade to the ICD-10 transactions is on target and they expect to be ready on time. So get your wallet out and SPEND SOME MONEY!
What do I need to do now to prepare for the conversion to ICD-10?
Did you hear what I said? GET YOUR WALLET OUT!! And ...There are several steps you need to take to prepare for the conversion to ICD-10.
-
Begin by talking to your practice management or software vendor. Ask if the necessary software updates will be installed with your upgrades for the Version 005010 (5010) HIPAA transactions. If you do not use the HIPAA transactions, determine when they will have your software updates available and when they will be installed in your system. Your conversion to ICD-10 will be heavily dependent on when your vendor has the upgrades completed and when they can be installed in your system.
-
Talk to your clearinghouses, billing service, and payers. Determine when they will have their ICD-10 upgrades completed and when you can begin testing with them.
-
Identify the changes that you need to make in your practice to convert to the ICD-10 code set. For example, your diagnosis coding tools, “super bills”, public health reporting tools, etc.
-
Identify staff training needs and complete the necessary training.
-
Conduct internal testing to make sure you can generate transactions you send with the ICD-10 codes.
-
Conduct external testing with your clearinghouses and payers to make sure you can send and receive transactions with the ICD-10 codes
“ICD-10” is the abbreviated way to refer to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).
Explain the difference between ICD-10-CM and ICD-10-PCS.
ICD-10-CM is the diagnosis code set that will be replacing ICD-9-CM Volumes 1 and 2. ICD-10-CM will be used to report diagnoses in all clinical settings. ICD-10-PCS is the procedure code set that will be replacing ICD-9-CM Volume 3. ICD-10-PCS will be used to report hospital inpatient procedures only.
Will ICD-10-PCS replace CPT®?
No. ICD-10-PCS will be used to report hospital inpatient procedures only. The Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) will continue to be used to report services and procedures in outpatient and office settings.
Do I have to upgrade to ICD-10?
Yes. The conversion to ICD-10 is a HIPAA code set requirement. Providers, including physicians, are HIPAA “covered entities”, which means that you must comply with the HIPAA requirements.
Who else has to upgrade to ICD-10?
Health care clearinghouses and payers are also HIPAA covered entities, so they are required to convert to ICD-10 as well.
I thought HIPAA code set standards only applied to the HIPAA electronic transactions. What if I don’t use the HIPAA electronic transactions?
It is correct that HIPAA code set requirements apply only to the HIPAA electronic transactions. But, it would be much too burdensome on the industry to use ICD-10 in electronic transactions and ICD-9 in manual transactions. Payers are expected to require ICD-10 codes be used in other transactions, such as on paper, through a dedicated fax machine, or via the phone.
Why is ICD-9 being replaced?
The ICD-9 code set is over 30 years old and has become outdated. It is no longer considered usable for today’s treatment, reporting, and payment processes. It does not reflect advances in medical technology and knowledge. In addition, the format limits the ability to expand the code set and add new codes. Also, the Medical Conglomerate wants to make more money by forcing the hard working Doctor and his staff to spend more administrative time and money trying to comply with Medicare' s ridiculous demands.
All services and discharges on or after October 1, 2013 must be coded using the ICD-10 code set. The necessary system and workflow changes need to be in place by the compliance date in order for you to send and receive the ICD-10 codes.
Then you are SOL! Any ICD-9 codes used in transactions for services or discharges on or after October 1, 2013 will be rejected as non-compliant and the transactions will not be processed. You will have disruptions in your transactions being processed and receipt of your payments. Physicians are urged to set up a line of credit to mitigate any cash flow interruptions that may occur.
Do not expect there to be a delay in the ICD-10 compliance deadline. The Centers for Medicare & Medicaid Services (CMS) is responsible for oversight of compliance with the HIPAA code set requirements. CMS has made it clear that there will be no extension of the deadline for ICD-10. Work within Medicare to upgrade to the ICD-10 transactions is on target and they expect to be ready on time. So get your wallet out and SPEND SOME MONEY!
Did you hear what I said? GET YOUR WALLET OUT!! And ...There are several steps you need to take to prepare for the conversion to ICD-10.
-
Begin by talking to your practice management or software vendor. Ask if the necessary software updates will be installed with your upgrades for the Version 005010 (5010) HIPAA transactions. If you do not use the HIPAA transactions, determine when they will have your software updates available and when they will be installed in your system. Your conversion to ICD-10 will be heavily dependent on when your vendor has the upgrades completed and when they can be installed in your system.
-
Talk to your clearinghouses, billing service, and payers. Determine when they will have their ICD-10 upgrades completed and when you can begin testing with them.
-
Identify the changes that you need to make in your practice to convert to the ICD-10 code set. For example, your diagnosis coding tools, “super bills”, public health reporting tools, etc.
-
Identify staff training needs and complete the necessary training.
-
Conduct internal testing to make sure you can generate transactions you send with the ICD-10 codes.
-
Conduct external testing with your clearinghouses and payers to make sure you can send and receive transactions with the ICD-10 codes
MEDICARE AND THE 2011 ABN FORM in simple terms
Certainly you need to consult with the Medicare Website for the particulars, but here is a simple rendering of what the new ABN is all about:medical billing
The new ABN form will be mandatory for all Medicare Providers beginning November 1st, 2011. medical billing
ABN: Advance Beneficiary Notice is designed to protect the Medicare provider as well as the patient. If the patient signs the ABN form and you send a claim to Medicare and they, for any reason, refuse to pay, you can then turn to the patient for payment. You will have a written and signed document protecting your financial rights to payment. It is also good for the patient because he/she is fully informed on what they can expect from you and from Medicare as far as their financial obligations are concerned. medical billing
We have 1 form for you to download on this page, and it is for the Medicare (only) patient to sign when they come in for the first time to receive X-Rays and Exam. Medicare will not cover these services and the patient needs to be informed of that. Whatever your prices are, do not write anything on the form that will be seen as a “discount” or any form of inducement over $10.00 to get them in the office as a patient. Medicare is very clear that if there is any evidence of inducement over the value of $10.00, then the practitioner is committing insurance fraud. We have some Doctors that do offer coupon discounts, but because of the Medicare rule, they are very careful NOT to offer these discounts to Medicare patients. chiropractic billing
Fill in the patient’s name and you can use any inter-office ID number in the identification number space.
In the "D" box, write down "X-Ray" and "Exam" and maybe even "Therapy." Under REASON, you can state "Not covered" or "Non covered service." You need to put in an estimated cost. Only one cost needs to be put in that box, as it can cover all of the services listed. Also, the words “Non covered service” only needs to be listed once as it will apply to all of the services listed. chiropractic billing
OPTIONS
Most patients will go for Option #1. They want the service and they want it billed to Medicare and they understand that if Medicare does not pay, they are liable for payment. chiropractic billing medical billingOption #2: They want the service, but do not bill Medicare. You can bill another insurance company if they have another Primary carrier, or at that point they become a Cash Case. chiropractic billing medical billing
Option #3 says they are not interested in being one of your patients! They do not want treatment, and they will not pay for it anyway. chiropractic billing medical billing
What to do when they choose option #1:
Find out if they have secondary or supplemental insurance. Supplemental insurance will pick up the patient’s co-pay, whereas secondary insurance might pay for some of the services that Medicare does not pay, as well as the deductible. chiropractic billing medical billing
You can follow this procedure even if they do not have secondary, so just to keep things simple: Bill everything that the Doctor does. Bill it to Medicare even if Medicare does not pay, because the patient may have a secondary insurance that might pay for some of the non-covered services. chiropractic billing medical billing
Medicare covers the CMT codes 98940, 98941 and 98942. Always add the AT modifier, which denotes Active Treatment. This is all that Medicare covers! chiropractic billing medical billing
After the first visit, you can, as an example, bill 72010, which is Full Spine X-Ray. X-Ray and Exam is not covered by Medicare, so you will add the GY modifier, which means “non covered service.” If the Doctor does an adjustment on the same visit as the exam, then bill the exam code 99203 with a 25 modifier as well as the GY modifier. If the Doctor does not do an adjustment, then bill 99203 GY.
Added note: If the patient receives therapy, bill it with a GP as well as a GY modifier. GP means “therapy.” See this example: 97140 GP GY chiropractic billing medical billing
Have the patient sign and date the form, and if their handwriting is illegible, have the patient print their name also. Make a copy for your patient. Put your copy in the patient's file. chiropractic billing medical billing
Clink on the link below to download the OFFICIAL 2011 ABN instrucions:
2011 ABN INSTRUCTIONS
Click on this link below to download the 2011 ABN form:
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