Are you sick and tired of me talking about changes that aren’t going to happen for a while?  If you recall, I was blogging about G-Codes and Severity Modifiers seven months before it was even mandatory.  But if you know me, you will know that I am a planner.  Were you ready for Functional Limitation Reporting that is now mandatory and has been since July 1st?  Well, if you are a planner like me, then you aren’t having any issues submitting your claims and life is grand.  But if you didn’t plan ahead, you may have a different story to tell.

So, I am here to say one year and two months from now, it will be mandatory—-ICD-10!!  That’s right!  The date of October 1, 2014 is FIRM!

After reading my last sentence, some folks probably closed the blog but if you are a planner, then you are still reading—thanks for staying with me!!

ICD-10 will affect therapy claim processing because ICD-10 will be used to bill Medicare Part B therapy services.  This new classification system isn’t new—it’s been around for 34 years!!  That’s right!  The United Kingdom, France, Australia, Germany, and Canada have already implemented ICD-10 with the United Kingdom back in 1995!!

ICD-10 provides significant improvements through greater detailed information as well as the ability to expand to capture additional advancements in medicine.  What will this result in?  Well, there will be a much greater specificity and clinical information, updated medical terminology and classifications of diseases, codes that allow comparison of mortality and morbidity data, and better data for measuring care, designing payment systems, processing claims, making clinical decision, tracking public health, identifying fraud and abuse, and conducting research¹.

ICD-10 codes are 3-7 digits.  The first digit is a letter, the second digit is a number.  The 3rd-7th are either a letter or a number.  The decimal point is after the third digit.  I found a website that will convert your ICD-9 code to ICD-10—for the one ICD-9 code I entered to be converted, 18 ICD-10 codes populated on my computer screen.

The use of CPT codes on the fee for service claims will not change and CMS instructed providers to continue to use CPT codes to report the services provided.

As I mentioned in one of my Functional Limitation Reporting blogs, providers should contact their billing software providers to see when they will be ready to test ICD-10.  The conversations should be taking place now so you have plenty of time to be prepared.

Gina Tomcsik

Director of Compliance

Functional Pathways

¹Department of Health and Human Services Centers for Medicare & Medicaid Services; Medicare Learning Network, ICN 901044 April 2013

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