Currently, billing in the United States health care system is completely based off of the ICD-9-CM (International Classification of Diseases, 9th edition, Clinical Modification) code set. When treating and diagnosing patients, health care providers make notes on the symptoms of the patients and the services they have provided by using codes from the ICD-9 set. These codes are then used by insurance companies and other payers who determine how much to reimburse the health care providers for based off of the codes that have been submitted. This system has been somewhat successful, but it does have its shortcomings and because of this a new code set will be used starting October 1, 2015.
Changes With ICD-10
The health care industry has used the current ICD-9 code set for medical billing since 1979. Over the years the industry has changed greatly, yet the ICD-9 code set has changed very little and thus, it is outdated and not as effective as possible. This is why a new, much larger and more in-depth code set has been developed and will be rolled out in 2015. All health care providers that adhere to HIPAA guidelines must transition to the ICD-10 code set on October 1, 2015. The new ICD-10 code set will bring many changes with it. Currently, the ICD-9 code set contains around 14,000 different codes that are used for describing patient diagnoses. The ICD-10 code set will contain over 69,000 relevant diagnosis codes which is a major increase from ICD-9. The large number of additional codes will allow for more accurate patient diagnosis as the current code set is simply lacking in this area. The new code set will allow doctors to specify laterality (left or right) and severity of conditions which was previously not possible with the ICD-9 codes. Overall, the ICD-10 code set is much more in-depth than the current set which will allow for more accurate documentation. However, this also means that the chance for error is likely greater.
Risks With ICD-10
One of the main issues that medical billers currently face is trying to accurately code medical conditions. Coding accuracy is extremely important because if patient encounters are not coded properly the health care provider may not earn all of the reimbursement money that they are entitled to. In order for coders to code accurately they must receive detailed, thorough documentation from the physicians who provide the care and this is typically where the problems arise. Many doctors are not trained in or aware of coding practices and thus, their notes are insufficient. Now, with the implementation of a new code set that is almost 5 times larger than the original there is much more room for error and inaccuracies. It is going to be crucial for doctors to accurately document all patient interactions so that the coders can do their job properly.
Unlike the current ICD-9 set the ICD-10 code set is alphanumeric meaning that each digit can be a number or letter. In addition, codes in the ICD-9 set are 5 digits where as codes in the ICD-10 will be 7 digits. Both of these factors lead to the thousands of new codes that have been developed and also lead to a headache for coders. Coders are going to have to undergo extensive training to learn and understand all of the new codes because as stated earlier, accurate coding is essential for the success of health care providers. Health care providers may also lose out on codes that are not specific enough (meaning they don’t list severity, laterality, etc.) under the ICD-10 system. The bottom line is with the vast amount of new codes that are being implemented medical billers and coders are going to have to do a lot of work to keep up.
Ensure Your Practice’s Success
With the implementation of the ICD-10 code set many health care providers are worried about potential losses of revenue. They are worried that their staff members are not trained well enough on the new code set and note that the current ICD-9 code set is difficult enough to use accurately. Many health care providers cannot afford to lose out on any potential revenues and they must take the necessary steps to secure these revenues. The best way to guarantee that your practice will earn all of the reimbursement money that it should is to utilize the expertise of the coders from HCCCoders.com. Our coders are experienced professionals and have already been trained in great detail on the ICD-10 code set. Call or contact us today to start earning all of the revenues that your practice is entitled to.