ICD-10 Delayed Again

Medical Billing ICD-10 Delay

So, what are you waiting for?

Part one of a three part series.

Over the past six months we have regularly written about the changes about to take place in healthcare. Now, 2012 is here and the first of those changes, 5010 should be implemented by all medical practices. This is a mandatory first step in what will be the transition from ICD-9 to ICD-10.  It is also a step that will greatly impact your cash flow everyday that implementation is delayed.

And now speaking of delays, ICD-10 has been delayed.

Thank your lucky stars right? That is an emphatic “Wrong”.

Now that you have a bit more time you can create a stress free transitional environment for your practice. Don’t get caught behind the eight ball like 35% of practices did while implementing 5010. Those 35% hadn’t even addressed implementation until late in the third quarter of 2011. Four months is not conducive to stress-free transition, implementation and testing on the scale of 5010 much less ICD-10.

This series will launch a step-by-step process that will help your practice and staff ease into ICD-10 in a more stress-free and confident manner saving everyone the anxieties of last minute implementation.

We will also be launching an ICD-10 portal soon to make information available and easily accessible.

So let’s get right to it, stress-free ICD-10.

To foster a better understanding of ICD – 10, I have included a number of frequently asked questions (courtesy of the AMA) that range from basic to TMI (too much information),  simply in an effort to paint a clear picture of the who, what, where and why of ICD – 10.


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.

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? 
The delay instituted on February 16, 2012 is indefinite. That said, doctors are still encouraged to work toward compliance with system and workflow changes enabling transition and reception of ICD-10 codes.

What if I’m not ready by the compliance deadline? 
Any ICD-9 codes used in transactions for services or discharges after the established deadline 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.

There you have it, a pretty thorough foundation to begin our next conversation, Part 2 on ICD – 10.

In the interim, if you have any questions or would like to talk to someone directly about help with the transition to ICD – 10 CRT Medical Systems would like to be the people you speak with. CRT has been in business for over 30 years and there isn’t much we haven’t seen in technological developments, healthcare legislation and insurance carrier evasion tactics. With over 400 years of combined medical billing expertise there isn’t much we haven’t seen. That also means that we know what to look for in every aspect of effective medical billing services.

If you would like to know more please call me, CRT president, David Doyle @ 248-789-1700 or visit our medical billing company website.


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